The number of provider groups receiving federal independent dispute resolution decisions on ambulatory surgery center claims nearly doubled to 2,580 in 2025, up from 1,324 in 2024, according to an analysis from Sunlight.
Sunlight drew on CMS Federal IDR Public Use Files covering the first quarter of 2023 through the fourth quarter of 2025, with the latest release in July 2026. The analysis counts only decided disputes on clinician claims billed at ASCs.
Arbitrators chose the provider’s offer in 70% of 2025 ASC disputes. Plans forfeited another 13%, and plans prevailed in 17%.
CMS began publishing the plan’s first payment on disputed claims in July 2026, starting with disputes decided from July through December 2025. That data shows wide gaps between initial payments and awards on the two codes Sunlight examined:
Anesthesia for screening colonoscopy (CPT 00812): The median award exceeded the plan’s first payment by $900 per case across 18,750 line items. Providers won 71%, and about 3 in 10 cases came from the Phoenix area.
Single-level lumbar transforaminal epidural injection (CPT 64483): The median gap reached $13,764 across 555 line items, and providers won 90%. The New York-New Jersey area produced 7 in 10 cases, and plans initially paid $0 on 22%.
Small practices with fewer than 20 employees accounted for 31% of ASC IDR disputes, more than triple their 9% share in other care settings. In all, 1,853 small groups filed 70,294 ASC disputes.
Federal IDR applies to out-of-network clinicians working in in-network facilities for scheduled care. An ASC’s own facility fee falls outside its scope.
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