Answers / The infusion record
The infusion and injection IDR record
In the 2025 public use files, 127,513 disputes with an infusion or injection administration code, a J-code drug line, or a prescription drug code went to decision under the No Surprises Act, and providers won 86.26 percent. Volume was 5.99 times the 2024 level and the median decision took 30 days. Three filer domains brought 68.55 percent of the disputes, and Blue Cross Blue Shield of Texas was the plan in 42.9 percent.
Volume, speed, and default decisions
Infusion and injection disputes numbered 784 in 2023, 21,304 in 2024, and 127,513 in 2025. Quarterly volume rose from 797 in the first quarter of 2024 to 43,592 in the third quarter of 2025, 6.6 times the third quarter of 2024, then eased to 37,728 in the fourth quarter. Leaving out default decisions, providers won 81.9 percent in 2025; counting them, 86.26. Providers asked a median of 4.04 times the QPA, but plans offered a median of 1.0 times (the QPA itself), and winning offers came in at a median of 4.09 times. A median dispute took 42 days to decide in 2023, 37 in 2024, and 30 in 2025, and default decisions made up 28.35 percent of 2025 disputes against 28.56 percent in 2024.
What the administration and drug lines pay
Looking only at lines that report both a QPA and offers, the administration codes decided well above their benchmarks in 2025. IV push of a first drug (96374) had a median QPA of $127.28 and a median decided award of $454.35 across 27,590 lines, IV push of each added drug (96375) $93.90 and $576.00 across 30,457, hydration by the added hour (96361) $94.87 and $353.58 across 26,706, and an injection under the skin or into muscle (96372) $86.91 and $343.71 across 19,325. Provider wins on administration codes add up to $81.95 million in prevailing offers for 2025, up from $7.3 million in 2024. Drug lines are small-dollar: saline (J7030) had a median QPA of $14.62 and award of $91.90, and ketorolac (J1885) $8.07 and $38.75.
Filers and payers
The filing side is concentrated. Three filer domains brought 87,406 of the 127,513 disputes (68.55 percent) and five brought 102,699 (80.54 percent), out of 87 filer domains in all. On the plan side, Blue Cross Blue Shield of Texas was named in 54,725 disputes (42.9 percent); providers won 88.9 percent of them, 39.7 percent ended in default decisions, and winning offers came in at a median of 5.04 times the QPA. UnitedHealthcare followed with 12,849 disputes at a 79.7 percent provider win rate, Aetna with 11,740 at 86.8 percent, MultiPlan with 11,086 at 75.7 percent, Cigna with 4,844 at 86.2 percent, Centene with 3,664 at 97.2 percent (49.6 percent defaults), and Anthem with 3,494 at 90.7 percent.
Plan types and states
By plan type, self-insured employer plans accounted for 88,845 disputes (69.7 percent), individual-market plans for 15,379 (12.1 percent), and fully insured group plans for 13,712 (10.8 percent). Individual-market disputes ended in default decisions 51.9 percent of the time, and the 4,131 disputes that list no plan response ended that way 59.1 percent of the time. Texas produced 83,380 disputes, 65.4 percent of the total, with an 86.0 percent provider win rate; Blue Cross Blue Shield of Texas was the plan in 54,077 of them. Arizona had 6,145, California 5,834, Tennessee 5,027, Arkansas 4,899, and Oklahoma 3,456, where providers won 95.1 percent. Every one of these cuts can be pulled at idrexplorer.com, and Lido IDR sets its offers from them ahead of filing for a flat fee per arbitration.
Price your infusion lines against the record
Lido IDR sets offers for administration and drug lines from the decisions published for your payers, states, and settings, then files for a flat fee per arbitration. Talk to an IDR specialist.