What Anesthesia teams should benchmark
Anesthesia IDR outcomes are shaped by code mix. The same payer can look fair in one lane and misaligned in another. Start with the codes that dominate your disputed claims, then compare state and payer behavior.
The purpose of this page is to help a specialty leader or RCM team decide where the federal IDR data supports a closer claim-level review.
Top Anesthesia service codes
| Code | Service | Disputes | Provider win rate | Median award | Median award dollars |
|---|---|---|---|---|---|
| 00812 | Anesthesia for screening colonoscopy | 35,915 | 83.4% | 9.6x | $1,658 |
| 00731 | Anesthesia for upper GI endoscopic procedures | 18,781 | 83.5% | 6.5x | $1,620 |
| 00813 | Anesthesia for combined upper and lower GI endoscopy | 13,635 | 83.1% | 6.7x | $1,970 |
| 00811 | Anesthesia for lower intestinal endoscopy (e.g., colonoscopy) | 13,016 | 80.9% | 6.5x | $1,530 |
| 00840 | Anesthesia for lower-abdomen intraperitoneal procedures (e.g., laparoscopy) | 12,850 | 83% | 3.3x | $2,039 |
| 01400 | Anesthesia for open or arthroscopic knee joint procedures | 9,849 | 83.4% | 6.4x | $2,272 |
| 01967 | Neuraxial labor anesthesia (epidural for planned vaginal delivery) | 9,190 | 81.5% | 2.8x | $4,044 |
| 00790 | Anesthesia for upper-abdomen intraperitoneal procedures | 9,019 | 84.9% | 3.4x | $2,326 |
| 01480 | Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise speci | 7,827 | 83.3% | 6.3x | $2,288 |
| 01630 | Anesthesia for open or arthroscopic shoulder procedures | 7,327 | 84.1% | 6.0x | $2,860 |
| 00142 | Anesthesia for lens (cataract) surgery | 6,747 | 81% | 6.4x | $1,981 |
| 00170 | Anesthesia for intraoral procedures | 6,343 | 79.5% | 5.7x | $1,988 |
| 01810 | Anesthesia for procedures on nerves, muscles, and tendons of the forearm, wrist, or hand | 6,255 | 82.8% | 6.5x | $1,596 |
| 00400 | Anesthesia for procedures on the skin of the extremities or trunk | 5,961 | 83.6% | 4.5x | $1,420 |
| 01402 | Anesthesia for total knee replacement | 5,880 | 84.1% | 4.9x | $2,975 |
All Anesthesia benchmark codes
| Code | Service | Disputes |
|---|---|---|
| 00812 | Anesthesia for screening colonoscopy | 35,915 |
| 00731 | Anesthesia for upper GI endoscopic procedures | 18,781 |
| 00813 | Anesthesia for combined upper and lower GI endoscopy | 13,635 |
| 00811 | Anesthesia for lower intestinal endoscopy (e.g., colonoscopy) | 13,016 |
| 00840 | Anesthesia for lower-abdomen intraperitoneal procedures (e.g., laparoscopy) | 12,850 |
| 01400 | Anesthesia for open or arthroscopic knee joint procedures | 9,849 |
| 01967 | Neuraxial labor anesthesia (epidural for planned vaginal delivery) | 9,190 |
| 00790 | Anesthesia for upper-abdomen intraperitoneal procedures | 9,019 |
| 01480 | Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise speci | 7,827 |
| 01630 | Anesthesia for open or arthroscopic shoulder procedures | 7,327 |
| 00142 | Anesthesia for lens (cataract) surgery | 6,747 |
| 00170 | Anesthesia for intraoral procedures | 6,343 |
| 01810 | Anesthesia for procedures on nerves, muscles, and tendons of the forearm, wrist, or hand | 6,255 |
| 00400 | Anesthesia for procedures on the skin of the extremities or trunk | 5,961 |
| 01402 | Anesthesia for total knee replacement | 5,880 |
| 01992 | Anesthesia for nerve-block pain procedures, prone position | 5,632 |
| 01961 | Anesthesia for cesarean delivery | 5,579 |
| 00160 | Anesthesia for nose and sinus procedures | 5,403 |
| 00952 | Anesthesia for hysteroscopy | 4,974 |
| 00670 | Anesthesia for extensive spine and spinal cord procedures | 4,768 |
| 00300 | Anesthesia for procedures on the head, neck, or posterior trunk | 4,396 |
| 00902 | Anesthesia for anorectal procedures | 4,376 |
| 01830 | Anesthesia for open procedures on the distal radius, ulna, wrist, or hand joints | 3,781 |
| 01214 | Anesthesia for total hip replacement | 3,704 |
| 01938 | Anesthesia for percutaneous image-guided spine injection/drainage, lumbar or sacral | 3,639 |
| 00126 | Anesthesia for tympanotomy (ear tube surgery) | 3,554 |
| 00918 | Anesthesia for transurethral removal of ureteral stones (lithotripsy) | 3,455 |
| 00910 | Anesthesia for transurethral bladder procedures (e.g., cystoscopy) | 3,172 |
| 01922 | Anesthesia for X-ray or radiation therapy | 2,827 |
| 00320 | Anesthesia for other procedure on neck area (1 year or older) | 2,609 |
| 00630 | Anesthesia for other procedure on lower spine | 2,434 |
| 00402 | Anesthesia for reconstruction of breast | 2,346 |
| 00537 | Anesthesia for procedure to assess heart electrical activity | 2,291 |
| 01470 | Anesthesia for other procedure on nerves, muscles, tendons, and tissue of lower leg, ankle | 2,136 |
| 00873 | Anesthesia for shock wave therapy for urinary system stones without water bath | 2,106 |
| 00940 | Anesthesia for other procedure on female genitals | 2,084 |
| 01940 | Anesthesia for nerve destruction procedures on spine or spinal cord of lower back accessed | 2,020 |
| 00920 | Anesthesia for other procedure on male genitals | 1,937 |
| 01610 | Anesthesia for procedure on nerves, muscles, tendons, fascia, and bursae of shoulder and u | 1,864 |
| 00797 | Anesthesia for procedure on stomach for weight loss | 1,849 |
| 01930 | Anesthesia for therapeutic interventional radiological procedures involving the venous/lym | 1,833 |
| 00732 | Anesthesia for procedure on gallbladder, pancreas, or liver using an endoscope | 1,818 |
| 01968 | Anesthesia for cesarean delivery following labor | 1,780 |
| 01937 | Anesthesia for injection, drainage or aspiration procedures on spine or spinal cord of nec | 1,579 |
| 01965 | Anesthesia for incomplete or missed abortion | 1,560 |
| 00520 | Anesthesia for other closed procedure on chest | 1,559 |
| 00140 | Anesthesia for other procedure on eye | 1,489 |
| 00860 | Anesthesia for other procedure on lower abdomen outside abdominal cavity | 1,457 |
| 00830 | Anesthesia for other repair of lower abdomen hernia (1 year or older) | 1,351 |
| 00532 | Anesthesia for access to central vein | 1,350 |
| 00145 | Anesthesia for retinal surgery | 1,307 |
| 01939 | Anesthesia for nerve destruction procedures on spine or spinal cord of neck or upper back | 1,214 |
| 01710 | Anesthesia for other procedures on nerves, muscles, tendons, and tissue of upper arm and e | 1,178 |
| 99135 | Use of low blood pressure complicating anesthesia | 1,159 |
| 00752 | Anesthesia for procedure to repair upper abdominal incisional hernia and/or wound opening | 1,152 |
| 00120 | Anesthesia for other procedure on external middle and inner ear | 1,133 |
| 01638 | Anesthesia for open or endoscopic total shoulder joint replacement | 1,089 |
| 00862 | Anesthesia for procedure on upper urinary tubes or removal of kidney for transplant | 1,064 |
| 00865 | Anesthesia for extensive removal of prostate | 992 |
| 01202 | Anesthesia for procedure on hip joint using an endoscope | 974 |
| 01472 | Anesthesia for repair of Achilles tendon | 949 |
| 01942 | Anesthesia for nerve modulation procedure spinal cord or repair of bone of spine of lower | 949 |
| 01320 | Anesthesia for procedure on nerves, muscles, tendons, and tissue of knee | 944 |
| 00914 | Anesthesia for removal of prostate including use of an endoscope | 895 |
| 99140 | Emergency condition complicating anesthesia | 873 |
| 01392 | Anesthesia for procedure on kneecap and/or upper part of lower leg bones | 825 |
| 00944 | Anesthesia for vaginal removal of uterus | 787 |
| 00450 | Anesthesia for other procedure on collar bone and shoulder blade | 754 |
| 01740 | Anesthesia for other procedure on elbow | 717 |
| 01464 | Anesthesia for procedure on ankle or foot using an endoscope | 704 |
| 01991 | Anesthesia for nerve block and injection | 682 |
| 00103 | Anesthesia for procedure on eyelid | 654 |
| 00210 | Anesthesia for other procedure on brain | 641 |
| 00567 | Anesthesia for heart artery bypass grafting on heart-lung machine | 640 |
| 00250 | PHARMACY-GENERAL | 636 |
| 00562 | Anesthesia for procedure on heart and large blood vessels using heart-lung machine (1 year | 625 |
| 01820 | Anesthesia for closed procedure on bones of forearm, wrist, or hand | 618 |
| 00912 | Anesthesia for removal of urinary bladder tumors including use of an endoscope | 609 |
| 01966 | Anesthesia for induced abortion | 596 |
| 00921 | Anesthesia for vasectomy | 584 |
| 01926 | Anesthesia for X-ray on artery of brain, heart, or chest | 578 |
| 01250 | Anesthesia for procedure on nerves, muscles, tendons, and tissue of upper leg | 554 |
| 00832 | Anesthesia for repair of abdominal wall hernia | 551 |
| 01714 | Anesthesia for repair of elbow to shoulder tendon | 517 |
Top states for Anesthesia disputes
| State | Disputes | Provider win rate | Median award |
|---|---|---|---|
| Texas | 68,930 | 86.5% | 4.6x |
| Arizona | 59,809 | 80.4% | 18.0x |
| Florida | 50,412 | 82.6% | 2.3x |
| Missouri | 17,069 | 82.9% | 10.2x |
| New Jersey | 15,970 | 80.5% | 2.9x |
| Tennessee | 13,053 | 89.5% | 2.5x |
| North Carolina | 11,493 | 91.4% | 1.7x |
| Ohio | 10,149 | 88.3% | 2.5x |
| New York | 7,574 | 77.6% | 8.0x |
| Oklahoma | 5,779 | 90.8% | 8.9x |
Top payers in Anesthesia
| Payer | Disputes | Provider win rate | Median award |
|---|---|---|---|
| UnitedHealthcare | 79,797 | 81.2% | 4.2x |
| Cigna / MultiPlan | 42,895 | 80.8% | 3.2x |
| Aetna | 33,817 | 88% | 7.8x |
| Cigna | 32,345 | 84.7% | 2.6x |
| UMR (clearhs.com) | 20,608 | 83.1% | 4.3x |
| BCBSAZ | 20,276 | 80.5% | 34.3x |
| BCBSTX | 18,177 | 95.4% | 8.3x |
| Anthem Blue Cross | 16,522 | 86.1% | 3.1x |
| UMR (clearhealthcloud.com) | 6,891 | 86.1% | 2.1x |
| Cigna / Zelis | 4,701 | 83.4% | 2.3x |
Filing checklist before you take Anesthesia claims to IDR
- Confirm the claim is NSA-eligible: emergency care, or out-of-network care at an in-network facility, with no state arbitration law that displaces the federal process for that plan type.
- Start open negotiation within 30 business days of the initial payment or denial notice. The negotiation window then runs 30 business days.
- If negotiation fails, initiate federal IDR through the portal within 4 business days after the window closes.
- Batch same-payer items in the same service code category. Open negotiation periods starting on or after November 1, 2026 can batch up to 50 line items per dispute, up from 25.
- Budget for fees: the federal administrative fee is $15 per party for disputes initiated on or after June 11, 2026 (down from $115), and the non-prevailing party pays the certified IDR entity fee.
- Anchor your offer to the data: the Anesthesia median provider-won award is 5.0x QPA across 305,512 disputes.
The fee and batching changes come from the May 2026 federal IDR operations final rule. See the 2026 and 2027 No Surprises Act changes guide for the full timeline, or request a free NSA audit to see how your claims compare.
Open the Anesthesia dashboard
Filter Anesthesia disputes by state, payer, and year to compare the public benchmark with your own out-of-network payment experience.
FAQ
How many Anesthesia federal IDR disputes are in the dataset?
This benchmark shows 305,512 Anesthesia disputes.
What is the Anesthesia provider win rate?
The non-default provider win rate is 83.2%.
What should Anesthesia groups compare first?
Start with service-code mix, then narrow by payer and state. That sequence usually gives a more useful answer than a national specialty average.
What changes in 2026 and 2027 affect Anesthesia IDR filings?
The administrative fee dropped to $15 per party for disputes initiated on or after June 11, 2026, batching expands to 50 line items for open negotiation periods starting on or after November 1, 2026, and standardized CARC/RARC remittance codes arrive January 1, 2027.
Related benchmarks
Sources and method
Providers won 85.8% of 3.39 million federal IDR disputes through 2025Q4, with a median provider-won award of 4.7x the qualifying payment amount, per CMS public use files.
- CMS: Federal IDR reports and public use files
- CMS: Federal IDR operations final rule fact sheet
- CMS: Federal IDR timeline for claims
Data source: CMS Federal IDR public use files, coverage through 2025Q4; data build 2026-09-24. Counts are CMS dispute counts unless a table says line items. Win rates on this page exclude payer no-show defaults unless labeled otherwise. Award multiples are medians versus the qualifying payment amount (QPA). Dollar figures, where shown, come from CMS QPA-and-offer fields or are anchored estimates, not payment records. This page is informational, not legal or reimbursement advice.