IDR for emergency medicine: the ED arbitration record
Half of all federal IDR volume is emergency medicine. What the 2025 record shows, why every ED claim qualifies, and how groups file at scale.
The No Surprises Act was written around the emergency department, and the arbitration data shows it: CMS published 1,130,093 emergency medicine disputes for 2025, slightly more than half of everything filed nationally. Emergency groups won 84.6 percent of decided disputes at a median of 3.92 times the payer benchmark, against payers whose median offer was the benchmark itself. This site explains how the process works for ED claims, grounded entirely in the published record.
All 3.39 million federal IDR disputes published by CMS, 2023 through 2025. Explore the data at idrexplorer.com.
Federal IDR is the No Surprises Act arbitration process for out-of-network claims, and emergency medicine is most of it: CMS published 1,130,093 emergency disputes for 2025, about 52 percent of national volume. Emergency groups won 84.6 percent of decided disputes, the median award was 3.92 times the qualifying payment amount across decided line items, and the median decision took 29 days. Every out-of-network emergency claim in a commercial plan qualifies; consent waivers do not exist for emergency care.
Emergency care is the core of the statute
Nobody chooses a network at 2 a.m., which is the fact the No Surprises Act is built on. When an out-of-network emergency physician treats a commercially insured patient, the claim is protected automatically: in a hospital ED, in a licensed freestanding emergency department, anywhere emergency services are furnished. There is no consent form for the emergency itself, because the law does not allow one. The payer must respond to the claim within 30 days, and when the payment is short, the dispute belongs in federal IDR.
The 2025 record at national scale
Emergency medicine generated 1,130,093 published disputes in 2025, 51.8 percent of the national total, and won 84.6 percent of the ones arbitrators decided. The median award was 3.92 times the qualifying payment amount across decided line items, reached in a median of 29 days. The contrast inside those disputes is the whole story: the median payer offer was exactly 1.0 times the QPA, the benchmark and nothing more, and arbitrators sided with the provider offer about five times out of six. The quarterly multiple climbed all year, 3.2 in late 2024, 4.48 by late 2025.
What the E/M levels paid
The docket is the E/M ladder. Level 4 visits, 99284, appear in 603,194 disputes with a median QPA of $216.05 and a median decided award of $720.34. Level 5, 99285, appears in 303,070 and paid a median of $914.25 against $292.14, with the highest win rate of the big codes at 86.7 percent. Level 3, 99283, was decided at 4.75 times its benchmark across 215,893 disputes, and the small level 2 volume ran 7 times. These are the most heavily litigated service codes in the country, and the outcomes barely move: payer benchmarks for emergency care lose, at every level of acuity.
Costs and the math at volume
Per dispute, the fixed costs are a $15 administrative fee per party and a certified IDR entity fee of a few hundred dollars returned to the winner, with same-code claims batchable into single disputes. Representation is where ED economics get decided. Decided emergency awards totaled nearly $5 billion in 2025, and a contingency vendor keeping 10 to 25 percent of recoveries scales with every one of those dollars; Lido IDR files for a flat fee per arbitration instead. Every statistic on this site comes from the CMS public use files, explorable at idrexplorer.com.
Common questions
Can emergency physicians use federal IDR?
Yes, categorically. Every out-of-network emergency claim for a commercially insured patient qualifies, from the screening exam through stabilization, in hospital EDs and licensed freestanding emergency departments alike. No consent waiver exists for emergency care. Medicare, Medicare Advantage, Medicaid, TRICARE, and workers compensation are outside the federal process.
What does emergency medicine win in federal IDR?
In the 2025 public use files, emergency groups won 84.6 percent of decided disputes, with a median award of 3.92 times the qualifying payment amount across decided line items and a median decision in 29 days. Emergency medicine was 51.8 percent of all federal IDR volume.
What do ED visit codes pay in federal IDR?
In the published files, level 4 visits (99284) paid a median decided award of $720.34 against a $216.05 QPA, level 5 (99285) paid $914.25 against $292.14 at an 86.7 percent win rate, and level 3 (99283) was decided at 4.75 times its benchmark.
Can a patient waive surprise billing protection for emergency care?
No. Notice-and-consent waivers are prohibited for emergency services, from the screening exam through stabilization. Only post-stabilization care can ever be waived, and only once the patient is stable, able to travel without medical transport, and given proper notice with an in-network option.
What does filing cost an emergency group?
A $15 administrative fee per party per dispute plus a refundable certified IDR entity fee of a few hundred dollars, with same-code claims batchable into one dispute. At ED volume the real cost is representation: contingency vendors keep 10 to 25 percent of recoveries, while Lido IDR charges a flat fee per arbitration.
Talk through your numbers
Book 30 minutes with an NSA/IDR specialist. Bring your payer mix and rough out-of-network claim volume, and we will walk through which claims are eligible, what similar providers are winning at IDR, and what a flat fee arrangement looks like. Three quick questions, then pick a time.
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