IDR for surgery centers: the surgery center claim record
What claims billed at surgery centers won in 2025, which clinicians qualify, and what the anesthesia and procedure codes pay.
Disputes with a line billed at a surgery center (place of service 24) grew from 61,047 in 2024 to 162,740 in 2025, and providers won 83.05 percent. Two of every three include an anesthesia code, so the record is largely anesthesiologists, along with surgeons, monitoring teams, and pain physicians. This site explains which clinicians qualify, what the codes pay, and where the volume sits, as the published files show it.
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. Claims with a line billed at an ambulatory surgery center (place of service 24) reached it 162,740 times in 2025, and providers won 83.05 percent; 65.04 percent of those disputes included an anesthesia code. A surgery center is a covered facility under the Act: at an in-network center, an out-of-network anesthesiologist, pathologist, radiologist, or assistant surgeon cannot balance bill the patient or ask for a waiver, and an unresolved payment goes to federal IDR for the plans it covers.
Volume grew 2.67 times in a year
Disputes with a line billed at a surgery center numbered 5,034 in 2023, 61,047 in 2024, and 162,740 in 2025, which is 2.67 times the year before. Quarterly volume rose from 5,438 in the first quarter of 2024 to 32,078 in the first quarter of 2025 and 44,709 in the fourth. Providers won 78.65 percent of disputes in 2023, 84.1 in 2024, and 83.05 in 2025 (82.32 percent when default decisions are left out). The median time to a decision fell from 57 days in 2023 to 47 in 2024 and 31 in 2025. A default decision, where one side never submits an offer, ended 14.74 percent of 2025 disputes, down from 20.76 percent in 2024. Surgery center disputes are 7.46 percent of the 2025 total of 2,180,938.
Two of every three include anesthesia
Of the 162,740 disputes, 105,843 (65.04 percent) include an anesthesia code. Anesthesia for a screening colonoscopy (00812) appears in 20,409 disputes, 12.54 percent of the total, followed by upper endoscopy anesthesia (00731) in 7,041, lower endoscopy anesthesia (00811) in 6,646, and the combined code (00813) in 6,528. Further down are cataract surgery anesthesia (00142) in 4,859 disputes, knee procedure anesthesia (01400) in 4,518, and prone-position nerve block anesthesia (01992) in 3,774. Outside anesthesia, the most frequent lines are limited-muscle electromyography (95870) in 2,719 disputes, vein ablation (36475) in 2,221, and transforaminal epidural injections (64483) in 2,166. A dispute averages 1.42 lines, 230,735 in all.
Filers, payers, and states
Three filer domains brought 69,447 of the 162,740 disputes (42.67 percent) and five brought 92,402 (56.78 percent), out of 183 filer domains in all. Only 23,108 disputes (14.2 percent) carry a filer group name that mentions a surgery center, surgical center, surgicenter, ambulatory care, or ASC, which suggests most filings come from the clinician groups working inside centers. UnitedHealthcare was the plan in 33,733 disputes (20.7 percent; providers won 79.7), Aetna in 25,591 (88.9 won), MultiPlan in 24,056 (80.6), Anthem in 12,873 (85.8), Blue Cross Blue Shield of Arizona in 12,672 (79.4), and Cigna in 10,638 (82.2). Arizona produced 36,549 disputes (22.5 percent), New Jersey 30,159 (18.5), and Texas 23,002 (14.1), together 55.12 percent. Winning offers ran at a median 25.39 times the QPA in Arizona and 44.9 in New Jersey, against 6.69 in Texas and 2.52 in Florida.
Plan types and filing costs
Self-insured employer plans were the plan type in 122,344 disputes (75.2 percent), fully insured group plans in 16,852 (10.4 percent), non-federal government plans in 9,978 (6.1 percent), and individual-market plans in 5,286 (3.2 percent). Another 5,816 disputes list no plan response, and 32.1 percent of those ended in default decisions. Every dispute costs each side a $15 administrative fee, and the winner is refunded the fee it paid the IDR entity. Lido IDR files for a flat fee per arbitration, with each offer set from the decided surgery center results at idrexplorer.com.
Common questions
Can surgery center claims use federal IDR?
Yes. A clinician who is out of network with the plan but works at an in-network surgery center can use it, under plans the federal process covers. A surgery center is a covered facility under the No Surprises Act, and anesthesiologists, pathologists, radiologists, and assistant surgeons cannot ask patients to waive the protection there. Surgeons can use a notice and consent form in some scheduled cases. Medicare, Medicare Advantage, Medicaid, and TRICARE are excluded from the process.
What do surgery center claims pay in federal IDR?
In the 2025 files, providers won 83.05 percent of the 162,740 disputes. Anesthesia for a screening colonoscopy (00812) carried a median QPA of $245.43 and a median decided award of $1,755.00 across 32,471 lines billed at surgery centers that report a QPA and offers.
Do surgery centers file these disputes themselves?
Rarely. Only 14.2 percent of 2025 disputes carry a filer group name that mentions a surgery center, surgical center, surgicenter, ambulatory care, or ASC, so most filings likely come from the clinician groups working there. A center's own fee for scheduled care is generally outside federal IDR, because the Act covers out-of-network clinicians at in-network facilities.
How long does a surgery center dispute take to decide?
Surgery center disputes reached a decision in a median of 31 days in the 2025 files, against 47 days in 2024 and 57 in 2023. In 14.74 percent of disputes, the case ended in a default decision after one side failed to submit an offer.
What does filing cost an anesthesia or surgery group?
Each side pays a $15 administrative fee for every dispute, and the certified IDR entity's fee is paid up front and refunded to whoever wins. A billing firm paid a percentage takes its cut of each award, so its cost grows with the award. Lido IDR files for a flat fee per arbitration, which suits groups with thousands of modest anesthesia cases.
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