Federal IDR by state
State rules. Federal IDR outcomes.
See where state surprise-billing rules may apply, then compare federal IDR volume, provider offer selection, offer levels, defaults, and time to determination using the 2025 CMS Public Use Files.
2025 Q1–Q4 · Air ambulance excluded · Closing-quarter basis
US claim lines
5,722,653
Deduplicated to latest quarterly record
Decided lines
5,435,587
No-decision lines excluded
Provider win rate
86.4%
Defaults count as losses
Median prevailing offer
399%
Of QPA
2,180,938 disputes in the 2025 files.
2.4% default-loss share of lines.
35 days median time to determination.
First state pages
Forty-nine states plus Washington, DC clear the minimum 100-decided-line gate. Recourse publishes detail pages only for the ten states with the most decided lines in the supplied 2025 analysis.
Federal IDR outcomes by state
The table ranks the 15 states with the most claim lines in the supplied 2025 analysis. A win is a decided line where the provider offer was selected. Default decisions count as losses in win rate and are also reported separately.
| State | Lines | Disputes | Decided | Provider win | Provider offer / QPA | Prevailing / QPA | Default-loss share | Median days |
|---|---|---|---|---|---|---|---|---|
| Texas | 2,535,967 | 869,943 | 2,349,738 | 86.7% | 560% | 480% | 1.9% | 32 |
| Arizona | 440,016 | 160,511 | 425,283 | 83.4% | 604% | 480% | 2.4% | 38 |
| Florida | 383,111 | 143,284 | 378,955 | 88.0% | 280% | 259% | 3.3% | 41 |
| Tennessee | 231,351 | 72,486 | 227,457 | 83.8% | 331% | 284% | 2.7% | 43 |
| California | 209,891 | 69,665 | 205,718 | 88.5% | 289% | 263% | 0.9% | 36 |
| New York | 172,610 | 79,676 | 172,358 | 86.5% | 606% | 538% | 1.9% | 44 |
| Georgia | 169,465 | 71,620 | 160,452 | 86.0% | 323% | 298% | 3.9% | 41 |
| New Jersey | 157,940 | 105,243 | 157,566 | 86.0% | 1,993% | 1,348% | 1.8% | 37 |
| Indiana | 135,879 | 70,413 | 135,839 | 87.3% | 406% | 359% | 1.9% | 34 |
| Oklahoma | 120,928 | 49,638 | 117,971 | 92.7% | 579% | 523% | 0.9% | 32 |
| Arkansas | 96,295 | 34,507 | 96,022 | 87.6% | 616% | 485% | 1.0% | 35 |
| Nevada | 82,961 | 35,739 | 82,804 | 91.5% | 285% | 273% | 0.8% | 40 |
| Louisiana | 82,903 | 49,366 | 82,677 | 76.1% | 482% | 381% | 3.0% | 32 |
| Ohio | 82,269 | 48,178 | 82,223 | 86.9% | 294% | 271% | 2.7% | 37 |
| Virginia | 69,803 | 37,825 | 69,789 | 84.2% | 374% | 330% | 4.3% | 44 |
Source: CMS Federal IDR Public Use Files, 2025 Q1 through Q4. Q1 and Q2 data as of January 21, 2026; Q3 and Q4 published July 15, 2026. See the Recourse methodology.
How to read these figures
The analysis uses all four 2025 quarterly OON emergency and non-emergency CMS PUF files. Air ambulance is excluded. Lines are deduplicated to the latest quarterly record.
Disputes are assigned to the quarter they closed. Quarterly values are labelled by closing quarter and should be read as descriptive snapshots. CMS publishes in arrears and can restate earlier records.
State is the PUF Location of Service field. Win rate is the share of decided lines where the provider offer was selected. Lines with no decision are excluded from both numerator and denominator. Default decisions count as losses.
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