Answers / The gastroenterology record
The gastroenterology IDR record
In the 2025 public use files, gastroenterology reached federal IDR under the No Surprises Act as 1,446 disputes filed by gastroenterologists, 3,032 with a GI procedure code, and 64,022 with an endoscopy anesthesia code. Providers won 86.1, 87.46, and 82.86 percent of them, and the median decision took 28, 28, and 31 days. Sedation disputes were 4.11 times the 2024 level and procedure disputes 6.1 times, while gastroenterologist-filed disputes grew 14.18 times from a base of 102.
Volume, speed, and default decisions
Gastroenterologist-filed disputes numbered 5 in 2023, 102 in 2024, and 1,446 in 2025, with 340, 311, 344, and 451 in the four quarters of 2025. Procedure disputes numbered 40, 497, and 3,032, and climbed from 389 in the first quarter of 2025 to 1,148 in the fourth. Sedation disputes numbered 998, 15,589, and 64,022, peaking at 17,874 in the third quarter of 2025 and easing to 17,226 in the fourth. Providers won 87.25 percent of the gastroenterologist-filed disputes in 2024 and 86.1 in 2025, 86.34 and 87.46 percent of the procedure disputes, and 84.69 and 82.86 percent of the sedation disputes. Leaving out default decisions, the 2025 rates were 85.62, 87.38, and 82.82 percent.
A median dispute took 30 days to decide in 2024 and 28 in 2025 for gastroenterologist-filed claims, 60, 40, and 28 days across 2023, 2024, and 2025 for procedure claims, and 54, 52, and 31 days for sedation claims. Default decisions, where one side never submitted an offer, made up 11.48 percent of the gastroenterologist-filed disputes in 2025 (29.41 percent in 2024), 13.56 percent of procedure disputes (19.92), and 13.71 percent of sedation disputes (19.13). Without defaults, providers asked a median of 44.99, 50.27, and 8.44 times the QPA, plans offered a median of 1.0, 1.0, and 1.17 times, and winning offers came in at 44.99, 46.44, and 7.98 times.
What the procedure and sedation lines pay
Among lines that report a QPA and offers, a colonoscopy with biopsy (45380) had a median QPA of $330.59 and a median decided award of $18,000.00 across 393 lines in 2025, and a colonoscopy with snare polyp removal (45385) $494.93 and $18,000.00 across 199. Upper endoscopy with biopsy (43239) had $212.12 and $15,000.00 across 912 lines, diagnostic colonoscopy (45378) $337.14 and $12,000.00 across 189, and upper endoscopy with snare removal of a lesion (43251) $271.26 and $21,500.00 across 54. Diagnostic upper endoscopy (43235) decided far lower, at $287.54 and $3,000.00 across 195 lines, while rigid proctosigmoidoscopy (45300) had a median QPA of $35.43 against a median award of $8,893.96 across 178. One filer domain brought 63.8 percent of the procedure disputes, so a few high-volume filers can set medians this size.
Sedation lines decide in a narrower range of dollars. Anesthesia for a screening colonoscopy (00812) had a median QPA of $247.22 and a median decided award of $1,620.00 across 45,298 lines, upper endoscopy anesthesia (00731) $288.91 and $1,604.12 across 19,876, the combined upper and lower code (00813) $316.75 and $1,981.00 across 14,840, and lower endoscopy anesthesia (00811) $271.05 and $1,512.00 across 12,804. Anesthesia for ERCP (00732) had $428.84 and $1,631.26 across 1,304. A procedure dispute averages 1.08 lines (3,271 in all) and a sedation dispute 1.71 (109,655 in all).
Filers and payers
Beyond the top procedure filer, the next four domains brought 238, 147, 120, and 113 procedure disputes. Practices with fewer than 20 employees filed 2,110 procedure disputes (69.6 percent) and those with 20 to 50 employees 547 (18.0 percent). Sedation filing is spread across larger groups: three filer domains brought 27,440 disputes (42.86 percent), and groups with 51 to 100 employees filed 20,085 (31.4 percent), while those with 20 to 50 employees filed 17,629 (27.5 percent) and won 78.7 percent.
Anthem was the plan in 910 procedure disputes (30.0 percent; providers won 89.7), Aetna in 488 (95.7 won), UnitedHealthcare in 458 (84.3), Blue Shield of California in 339 (76.1), and MultiPlan in 203 (79.8). Winning offers ran at a median 73.69 times the QPA where Anthem was the plan, 41.02 for UnitedHealthcare, 12.09 for Aetna, and 9.71 for MultiPlan. In sedation, UnitedHealthcare was the plan in 14,029 disputes (21.9 percent; 78.2 won), Aetna in 11,047 (89.7), MultiPlan in 7,857 (79.9), Blue Cross Blue Shield of Arizona in 7,107 (75.6), and Cigna in 5,707 (83.3). Winning offers ran at 35.27 times the QPA in the Arizona Blue disputes, against 9.35 for Aetna, 8.56 for UnitedHealthcare, and 3.29 for MultiPlan. Blue Cross and Blue Shield of Texas was named in 2,302 sedation disputes; providers won 95.7 percent and 29.9 percent ended in default decisions.
Plan types and states
Self-insured employer plans were the plan type in 2,436 procedure disputes (80.3 percent; 87.7 won) and 49,605 sedation disputes (77.5 percent; 82.7 won). Fully insured group plans were in 262 procedure disputes (8.6 percent), and those ended in default decisions 23.3 percent of the time against 11.3 percent for self-insured plans. The 78 procedure disputes that list no plan response ended in default decisions 53.8 percent of the time, and individual-market plans were in 3,138 sedation disputes (4.9 percent), with default decisions in 22.3 percent.
California providers won 88.9 percent of their procedure disputes and New York providers 79.0 percent, and winning offers ran at a median 81.13 times the QPA in California against 14.44 in New York, 8.27 in New Jersey, and 8.03 in Texas. In sedation, Arizona providers won 79.5 percent of 20,379 disputes at a median 25.32 times the QPA, against 4.09 in Texas, 2.46 in Florida, and 11.14 in Missouri (6,057 disputes). The state and payer cuts are at idrexplorer.com, and Lido IDR prices each GI offer against them before filing for a flat fee per arbitration.
Price your GI procedure and sedation lines against the record
Lido IDR checks each GI line against the decided results for your payers and states, then files for a flat fee per arbitration. Talk to an IDR specialist.