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Data & benchmarks
Federal IDR win rates by specialty
How often providers win out-of-network disputes under the No Surprises Act, broken down by specialty. Computed from the CMS Federal IDR Public Use Files for 2025, weighted by decided line items.
~92%
radiology — the highest specialty
3.35M
emergency-medicine line items — the largest
80%+
win rate in every major specialty
Provider win rate by specialty
| Specialty | Win rate | Decided line items | Notes |
|---|---|---|---|
| Radiology | 92.2% | ~936,000 | Highest win rate of any major specialty. |
| Hospitals & facilities | 87.1% | ~577,000 | Facility and observation claims. |
| Plastic & reconstructive surgery | 86.9% | ~29,000 | Reconstructive and microsurgery claims. |
| Pain management | 86.8% | ~50,000 | Interventional pain procedures. |
| Intraoperative neuromonitoring | 86.7% | ~197,000 | IONM during surgery — the patient never chose the provider. |
| Neurosurgery | 85.7% | ~10,000 | Cranial and spine surgical claims. |
| Emergency medicine | 85.2% | ~3,348,000 | By far the largest volume — the archetypal NSA claim. |
| Anesthesia | 83.1% | ~276,000 | Base-plus-time billing; below the average. |
| Orthopedic surgery | 81.5% | ~6,800 | Lowest of the specialties shown. |
CMS Federal IDR Public Use Files, calendar year 2025; win rate = provider-prevailing line items ÷ decided line items, grouped by specialty and weighted by volume. Figures rounded. Individual practices vary widely — many self-filing groups win well below these averages.
What the specialty data shows
- Every major specialty wins 80%+. From radiology (~92%) to orthopedics (~81.5%), providers prevail in the large majority of contested determinations.
- Emergency medicine dominates the volume. At ~3.35 million decided line items, it is larger than every other specialty combined — the archetypal No Surprises Act claim.
- Losses are process, not merits. Even surgical specialties that "should" win — neurosurgery, orthopedics — leave money on the table when deadlines slip or the offer isn't justified, not because the claim was weak.
Where does your specialty stand?
These are national averages. Sydra shows you your win and default rates by payer and CPT from the same CMS data — 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.