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Data & benchmarks
Federal IDR win-rate benchmarks
How often providers win out-of-network disputes under the No Surprises Act — overall and by specialty. These figures are drawn from the public CMS Federal IDR Public Use Files for 2025 (about 2.18 million determinations), the same data Sydra is built on.
~85%
provider win rate, all specialties (2025)
2.18M
federal IDR determinations in 2025
$115 → $15
IDR filing fee, per party (June 2026 rule)
Provider win rate by specialty
| Specialty | Win rate | Notes |
|---|---|---|
| All specialties (weighted) | ~85% | Providers prevail in the large majority of determinations. |
| Orthopedic / spine / neurosurgery | ~87% | Highest — surgical claims rarely lose. |
| Hospitals & facilities | ~86% | Facility and observation claims. |
| Emergency medicine | ~85% | The archetypal No Surprises Act claim. |
| Pathology & clinical labs | ~84% | Hospital-based reads the patient never chose. |
| Anesthesia | ~82% | Lowest of the major specialties — base-plus-time billing. |
Weighted by decided line items, CMS Federal IDR Public Use Files, calendar year 2025. Figures are rounded; individual practices vary widely — many self-filing groups win far below these benchmarks.
The 2026–2027 changes
- Lower fee. The IDR administrative fee dropped from $115 to $15 per party, per dispute (initiated on or after June 11, 2026) — smaller claims now pencil out.
- Bigger batches. From November 1, 2026, up to 50 related services can be batched into one dispute.
- Standardized payer codes. For items and services on or after January 1, 2027, payers must attach standardized CARC/RARC codes and their IDR registration number to every payment or denial.
Where does your practice stand?
If you're winning well below ~85%, the gap is almost always process — eligibility, deadlines, evidence, and offer justification — not the merits. Sydra shows you your win and default rates by payer and code, and closes the gap for a flat fee.
Medically & clinically reviewed by Dr. John M. Abrahams, MD
Board-certified neurosurgeon and founder of Sydra · Last reviewed September 2026 · About the author
Sources
Figures reflect the published federal record across all disputes, not a prediction about any individual claim. This is general information, not legal or financial advice.