IDR for radiologists: the imaging arbitration record
Which imaging claims qualify, what radiology groups won in 2025, and how small reads become real recoveries.
Radiology files more federal IDR disputes than any specialty except emergency medicine, and wins them at the highest rate of any high-volume specialty. CMS published 424,336 radiology and imaging disputes for 2025 alone. This site explains how imaging groups use the process, grounded entirely in the published federal 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 radiology is its second largest specialty. CMS published 424,336 radiology and imaging disputes for 2025. Radiologists won 89.5 percent of decided disputes that year, the median award ran 5.4 times the qualifying payment amount across decided line items, and the median decision took 35 days.
Why radiology fits the process
Patients almost never choose their radiologist. The hospital or the referring physician does, which is exactly the situation the No Surprises Act was written for. The law protects two kinds of radiology claims: emergency imaging, and out-of-network reads for patients seen at in-network hospitals and ambulatory surgery centers. Radiology also sits on the statute's ancillary list, which means a patient consent form can never strip those claims of protection. If a payer underpays a protected read, federal IDR is the forum that decides what it owes.
What the 2025 record shows
The CMS public use files for 2025 contain 424,336 disputes with radiology and imaging line items. Radiologists won 89.5 percent of the ones arbitrators decided, the strongest win rate of any high-volume specialty, and the median award ran 5.4 times the qualifying payment amount across decided line items. The median dispute took 35 days from arbitrator selection to decision. The biggest single code was CT of the abdomen and pelvis with contrast (74177), with 62,338 disputes and a median award of about $1,070 against a median QPA of $146. Screening mammography (77067) won 95.2 percent of decided disputes. United Healthcare and Aetna sat on the other side more than anyone else.
Small reads become real money in batches
A two-view chest X-ray carries a median QPA around $15, and nobody arbitrates a $15 claim by itself. The process is built for this: claims against the same payer for the same or similar services within a 30 business day window can be combined into a single dispute. Forty underpaid chest films against one payer is one arbitration, one set of fees, and a four-figure award. In 2025 the median decided chest X-ray line (71046) paid about $130, roughly 7.6 times its QPA. Batching is the reason imaging groups with high volumes of small reads collect through this process at all.
What filing costs a radiology group
Hard costs are modest: each party pays a $15 administrative fee per dispute, plus a certified IDR entity fee of a few hundred dollars that the winner gets back. The bigger decision is who runs the work, because every claim carries business-day deadlines and evidence requirements. Law firms and contingency vendors typically take 15 to 25 percent of what you recover. Lido IDR files for a flat fee per arbitration, so a group keeps the award. The full published record behind every number on this site is explorable at idrexplorer.com.
Common questions
Can radiologists use federal IDR?
Yes, for two kinds of claims: emergency imaging, and out-of-network reads for patients seen at in-network hospitals or ambulatory surgery centers. Radiology is on the No Surprises Act's ancillary list, so patient consent waivers cannot remove protection. Office imaging, Medicare, and Medicaid are outside the process.
What do radiologists win in federal IDR?
In the 2025 public use files, radiologists won 89.5 percent of decided disputes, the median award was 5.4 times the qualifying payment amount across decided line items, and the median decision took 35 days.
Is it worth arbitrating low-dollar imaging claims?
Individually, usually not. Batched, yes. Claims against the same payer for the same or similar services within a 30 business day window can go in as one dispute, so dozens of small reads share one set of fees. A chest X-ray line with a $15 QPA paid a median of about $130 when decided in 2025.
Can a patient consent waiver block a radiology claim?
No. The No Surprises Act makes notice-and-consent waivers unavailable for ancillary services, and the list names radiology and diagnostic services specifically. A protected imaging claim stays protected no matter what the patient signed.
What does it cost an imaging group to file?
A $15 administrative fee per party per dispute, plus a certified IDR entity fee of a few hundred dollars that is refunded to the winner. Contingency vendors and law firms usually charge 15 to 25 percent of recovery; 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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