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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 capped fee, a fraction of contingency.
Use this data
These figures are derived from the public federal record and are free to reuse with attribution. If you cite them, a link back helps other people find the source.
Suggested citation
Sydra Health. "Federal IDR outcomes by service code, 2025." Derived from the CMS Federal IDR Public Use Files, calendar 2025 (2,180,938 determinations). https://www.sydrahealth.com/resources/idr-benchmarks
Method
Computed from the CMS Federal IDR Public Use Files for calendar 2025 — every determination the certified IDR entities reported, 2,180,938 in total. Win rate is the share of decided line items resolved in the provider's favour. The median award is per decided line item; the median QPA column is a per-unit benchmark rate. The two are not a like-for-like ratio and should not be divided.
Figures describe the published federal record in aggregate. They are not a prediction about any individual claim, and outcomes vary by payer, documentation and offer strategy.
Questions about the methodology, or want a cut of the data that isn't published here? Get in touch — we would rather you quote it accurately.
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.