Answers / The emergency record
The emergency medicine IDR record
CMS published 1,130,093 federal IDR disputes with emergency medicine line items for 2025, 51.8 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. Decided emergency awards totaled nearly $5 billion for the year.
Half the federal docket
Emergency medicine's 1,130,093 disputes in 2025 were 51.8 percent of everything filed in federal No Surprises Act arbitration nationally, and the volume kept rising: 135,618 disputes in the third quarter of 2024, 330,245 in the third quarter of 2025. Texas alone filed 500,277, with a median multiple of 5.88. The win rate barely moved while volume more than doubled, holding between 82 and 86 percent every quarter, and the median decided multiple climbed steadily, 3.2 in late 2024, 4.48 by the end of 2025. Scale has not softened the outcomes; it has hardened them.
The E/M ladder and what it paid
Four visit codes carry the docket. The level 4 visit, 99284, is the single most disputed service code in the country, 603,194 disputes, with a median QPA of $216.05 and a median decided award of $720.34 at an 85 percent win rate. Level 5 (99285) paid $914.25 against a $292.14 benchmark and won 86.7 percent, the best rate among the big codes. Level 3 (99283) was decided at 4.75 times its QPA across 215,893 disputes, and the modest level 2 volume (99282) ran 7.01 times. The pattern is uniform across acuity: arbitrators priced every rung of the ladder at multiples of the benchmark.
The payers across the table
United Healthcare faced the most emergency disputes in 2025, 278,252, losing 85 percent of decided ones at a median of 3.01 times the QPA. Blue Cross Blue Shield of Texas was close behind at 250,327 with a strikingly higher median multiple of 7.77. Aetna sat at 137,992 disputes and lost 88.5 percent; Anthem Blue Cross plans accounted for 91,941 and lost 88.9 percent. No major payer won even a quarter of its decided emergency disputes, which is the context for every short initial payment an ED group receives.
Nearly five billion dollars in a year
Decided awards on emergency line items totaled $4.99 billion in 2025, on 1.7 million decided lines with a median QPA of $248.90 and a median award of $850.57. That is the gap between what payers priced and what a neutral decided the care was worth, realized one dispute at a time by the groups that filed. The code-level and payer-level record is explorable at idrexplorer.com, and Lido IDR prices offers from it and files for a flat fee per arbitration.
Price your ED claims against the record
Lido IDR anchors offers to published awards for your visit codes and payers, then files for a flat fee per arbitration. Talk to an IDR specialist.