IDR for infusion: the infusion and injection claim record
What infusion and injection lines won in 2025, which settings qualify, and what the administration and drug codes pay.
Infusion and injection disputes grew about sixfold in a year, from 21,304 in 2024 to 127,513 in 2025, and providers won 86.26 percent. Here that means any dispute with an administration code for an IV, infusion, or injection, a J-code drug line, or a prescription drug code. Almost all of them are emergency department visits that happen to include an IV or an injection, which decides who qualifies. This site explains which settings are covered, what the administration and drug codes pay, and where the volume sits, working only from the published 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. Infusion and injection claims (any dispute with an administration code from 96360 through 96549, a J-code drug line, or the prescription drug codes S5000 and S5001) reached it 127,513 times in 2025, and providers won 86.26 percent. Care in a hospital or freestanding emergency department is an emergency service and qualifies. An infusion in a physician's office, a freestanding infusion suite, or the patient's home takes place at no covered facility.
Volume grew about sixfold in a year
The infusion and injection files grew from 784 disputes in 2023 to 21,304 in 2024 and 127,513 in 2025, which is 5.99 times the year before. Quarterly volume went from 797 in the first quarter of 2024 to a high of 43,592 in the third quarter of 2025, then eased to 37,728 in the fourth. Providers won 55.45 percent of disputes in 2023, 78.35 in 2024, and 86.26 in 2025 (81.9 percent when default decisions are left out), and the median time to a decision fell from 42 days in 2023 to 37 in 2024 and 30 in 2025. Default decisions, entered when one side never submitted an offer, ended 28.35 percent of the 2025 disputes. Together they are 5.85 percent of the 2,180,938 disputes CMS published for 2025.
Mostly emergency department visits that include an IV or injection
These are rarely stand-alone infusions. Of the 127,513 disputes, 119,559 (93.76 percent) also carry an emergency department visit code from 99281 through 99285. Of the 106,545 disputes with an administration code, 102,033 (95.77 percent) have an administration line billed at the emergency room place of service. Administration codes appear in 83.56 percent of all disputes and J-code drug lines in 57.82 percent; 56,609 carry both, 17,121 carry a drug line without an administration code, and 3,847 qualify only through the prescription drug codes S5000 and S5001. A dispute averages 3.37 lines, and 3,366 disputes carry ten lines or more.
Filers, payers, and the Texas concentration
Three filer domains brought 87,406 of the 127,513 disputes (68.55 percent), out of 87 filer domains in all. Blue Cross Blue Shield of Texas was the plan in 54,725 disputes (42.9 percent), where providers won 88.9 percent and 39.7 percent ended in default decisions. UnitedHealthcare followed with 12,849 disputes (79.7 percent won), Aetna with 11,740 (86.8), MultiPlan with 11,086 (75.7), and Cigna with 4,844 (86.2). Texas produced 83,380 disputes, 65.4 percent of the total, and Blue Cross Blue Shield of Texas was the plan in 54,077 of them. Arizona, California, Tennessee, and Arkansas each added between 4,899 and 6,145.
Plan types and filing costs
By plan type, self-insured employer plans accounted for 88,845 disputes (69.7 percent), individual-market plans for 15,379 (12.1 percent, with 51.9 percent ending in default decisions), and fully insured group plans for 13,712 (10.8 percent). A $15 administrative fee is due from each side on every dispute, and the IDR entity's fee goes back to the winner. Lido IDR files each dispute for a flat fee per arbitration, with offers priced from the decided infusion results at idrexplorer.com.
Common questions
Can infusion and injection claims use federal IDR?
Yes, when the care happened at a hospital emergency department or an independent freestanding emergency department. Those are emergency services under the No Surprises Act, and the patient cannot be asked to waive the protection. Claims paid by Medicare, Medicare Advantage, Medicaid, or TRICARE are outside the process.
What do infusion and injection lines pay in federal IDR?
Providers won 86.26 percent of the 127,513 disputes in the 2025 files, with winning offers at a median of 4.09 times the QPA. Lines for IV push of each added drug (96375) had a median QPA of $93.90 and a median decided award of $576.00.
Do standalone infusion centers and home infusion qualify?
Usually not. For care that is not an emergency, the No Surprises Act covers a patient only at one of four kinds of facility: a hospital, a hospital outpatient department, a critical access hospital, or an ambulatory surgical center. An infusion in a physician's office, a freestanding infusion suite, or the patient's home happens at none of them, and urgent care centers are generally not emergency facilities under the Act.
How long does an infusion dispute take to decide?
The median infusion and injection dispute in the 2025 files reached a decision in 30 days, against 37 days in 2024 and 42 in 2023. About 28.35 percent of disputes were default decisions, in which one side never submitted an offer.
What does filing cost an infusion billing team?
A $15 administrative fee is due from each side on every dispute, and the IDR entity's own fee is paid up front and refunded to the winner. Billing firms that work on a percentage keep a share of every award. Lido IDR files for a flat fee per arbitration, which suits groups that file thousands of small-dollar drug and administration lines each year.
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