Answers / The radiology record
The radiology IDR record
CMS published 424,336 federal IDR disputes with radiology and imaging line items for 2025. Radiologists won 89.5 percent of decided disputes, the best rate of any high-volume specialty, with a median award of 5.4 times the qualifying payment amount across decided line items and a median decision time of 35 days.
Second only to emergency medicine
Radiology is the second largest specialty in the federal No Surprises Act arbitration record. The 2025 public use files contain 424,336 disputes involving imaging line items, and quarterly volume grew through the year, peaking above 128,000 disputes in the second quarter. That scale reflects how imaging is organized: hospital-based groups read for facilities whose payer contracts they do not control, so a single stalled network negotiation can push an entire year of reads out of network.
Win rates by study type
Radiologists won 89.5 percent of decided 2025 disputes, and the pattern holds across the common studies. CT of the abdomen and pelvis with contrast (74177) was the single biggest code with 62,338 disputes, won 87.6 percent of the time, with a median decided award near $1,070 against a $146 median QPA. Head CT (70450) won 89.2 percent. Chest X-rays, both single view (71045) and two view (71046), won at 86 to 90 percent with awards of six to eight times their small QPAs. Screening mammography (77067) was the standout at 95.2 percent of decided disputes won.
Who sits on the other side
United Healthcare appeared in 121,297 of the 2025 radiology disputes, more than any other payer, followed by Aetna at 101,746, Blue Cross Blue Shield of Texas at 66,636, and Cigna at 49,603. Win rates stayed high across all of them, which matters for groups deciding whether a specific payer relationship is worth arbitrating: the record says the forum works against every major carrier.
What the multiples say about imaging QPAs
The qualifying payment amount is the payer's own median contracted rate, and in radiology the awards say arbitrators do not find those numbers credible. A 5.4x median award across decided line items means the typical winning imaging offer was more than five times the payer's benchmark. On high-volume CT codes the gap is starker: $146 QPAs against four-figure awards. Groups that price offers from the published record, by code and payer, are working with the same data arbitrators see. The full record is explorable at idrexplorer.com.
Benchmark your reads against the record
Lido IDR prices imaging offers from the published record for your codes and payers, then files for a flat fee per arbitration. Talk to an IDR specialist.