Answers / The critical care record
The critical care IDR record
In the 2025 public use files, 52,569 disputes with a critical care line were decided under the No Surprises Act, and providers won 88.07 percent at a median of 3.73 times the QPA. Volume rose 98 percent in a year and the median decision took 31 days, down from 81 in 2024. Five filer domains brought 70.47 percent of the disputes.
Volume, decision speed, and defaults
Each year of the files dwarfs the one before: 5,672 critical care disputes in 2023, 26,576 in 2024 (4.7 times as many), and 52,569 in 2025, a 98 percent rise. Quarterly volume went from 4,088 in the first quarter of 2024 to a peak of 14,790 in the second quarter of 2025, and the third quarter of 2025 ran 82 percent above the third quarter of 2024. Providers asked a median of 3.73 times the QPA in 2025 and plans offered 1.12 times. Excluding default decisions, providers won 87.95 percent; including them, 88.07. The median dispute took 79 days to decide in 2023, 81 in 2024, and 31 in 2025.
What a 99291 line pays
In 2025, 64,318 first-block lines (99291) reported a QPA and offers, against 28,398 in 2024 and 4,400 in 2023. The median QPA was $315.23 and the median decided award $1,077.10, and provider wins on the code add up to $131.8 million in prevailing offers, up from $44.2 million in 2024 and $4.8 million in 2023. The add-on code (99292) appears in 1,838 disputes, 3.5 percent of the total, and decided at a median of $2,400 against a $232.95 QPA; its wins add up to $3.5 million.
Filers and payers
The filing side is concentrated. Five filer domains brought 37,043 of the 52,569 disputes, 70.47 percent, out of 117 domains in all, and the largest of them alone filed 31.2 percent. On the other side, UnitedHealthcare was the plan in 16,723 disputes and providers won 88.2 percent of them. Aetna followed with 6,246 at 92.0 percent, Blue Cross Blue Shield of Texas with 5,913 at 88.0 percent and a 9.87 median multiple, Anthem with 5,596, MultiPlan with 4,196 at 80.7 percent, and Cigna with 1,666 at 80.1 percent. Default decisions were rare against UnitedHealthcare (9.6 percent) and common against Blue Cross Blue Shield of Texas (39.9 percent) and Blue Cross Blue Shield of Florida (79.1 percent).
Plan types and states
Self-insured employer plans produced 37,341 disputes (71.0 percent) and fully insured group plans in 6,967 (13.3 percent). Individual-market plans appeared in 2,278 disputes, with a 39.0 percent default rate and a 6.71 median multiple, and 3,789 disputes list no plan response at all, with 49.4 percent ending by default. Texas leads the states with 16,270 disputes, then Florida with 5,885, Georgia with 3,697, California with 3,013, and Arizona with 2,785. These cuts are open to anyone at idrexplorer.com, and Lido IDR sets each offer from them before filing for a flat fee per arbitration.
Price your critical care lines against the record
Lido IDR sets each 99291 and 99292 offer by payer, state, and setting from the results already decided, and files for a flat fee per arbitration. Talk to an IDR specialist.