IDR for gastroenterology: the GI claim record
What gastroenterologist, endoscopy, and sedation claims won in 2025, which settings qualify, and what the GI codes pay.
Gastroenterology reached federal IDR in three overlapping ways in 2025: 1,446 disputes filed under a gastroenterology specialty, 3,032 with a GI procedure code such as a colonoscopy or upper endoscopy, and 64,022 with an endoscopy anesthesia code. Providers won 86.1, 87.46, and 82.86 percent of them. The small physician counts and the large sedation count tell different stories, and this site explains both, along with which settings qualify and what the codes pay, with every number taken from the CMS dispute files.
All 3.39 million federal IDR disputes published by CMS, 2023 through 2025. Explore the data at idrexplorer.com.
Federal IDR is the No Surprises Act arbitration process for out-of-network claims. Gastroenterology claims reached it in three overlapping ways in 2025: 1,446 disputes filed under a gastroenterology specialty, 3,032 with a colonoscopy, endoscopy, or other GI procedure code, and 64,022 with an endoscopy anesthesia code, with provider win rates of 86.1, 87.46, and 82.86 percent. Procedures at an in-network surgery center, hospital outpatient department, or hospital are covered settings, and anesthesia is a service the patient cannot be asked to waive. A gastroenterologist's own scheduled care can fall outside the protection when the patient signs a notice and consent form, and a physician office is not a covered facility.
Three ways to count GI disputes
The public files do not tag a dispute as gastroenterology, so this site counts three ways. Disputes filed by a provider whose listed specialty is gastroenterology (not surgery, oncology, or bariatrics) numbered 5 in 2023, 102 in 2024, and 1,446 in 2025. Disputes with an upper endoscopy, colonoscopy, sigmoidoscopy, or other GI procedure code numbered 40, 497, and 3,032. Disputes with an endoscopy anesthesia code (00731 or 00732 for upper endoscopy, 00811 to 00813 for lower and combined procedures) numbered 998, 15,589, and 64,022. Together they are 0.066, 0.14, and 2.94 percent of the 2,180,938 disputes published for 2025. Providers won 86.1, 87.46, and 82.86 percent, and the median time to a decision was 28, 28, and 31 days.
Gastroenterologist-filed disputes are few and concentrated
Of the 1,446 disputes, 953 came from California and 472 from New York, 98.55 percent combined, and two filer domains brought 1,399 of them (96.75 percent). Practices with fewer than 20 employees filed 1,359 (94.0 percent). Anthem was the plan in 619 disputes (42.8 percent; providers won 88.4 percent), UnitedHealthcare in 269 (83.3 percent won), Aetna in 196 (87.2), Blue Shield of California in 117 (77.8), and Cigna in 77 (92.2). Winning offers came in at a median of 44.99 times the QPA, 11.48 percent of disputes ended in default decisions, and a dispute averages 1.91 lines (2,764 in all). The count says who files, not how many GI claims are underpaid.
Procedure disputes cluster in California
Among the 3,032 procedure disputes, California produced 1,771 (58.4 percent), New York 305, New Jersey 302, and Texas 173, and one filer domain brought 1,934 (63.8 percent). Upper endoscopy with biopsy (43239) appeared in 1,059 disputes, colonoscopy with biopsy (45380) in 481, diagnostic upper endoscopy (43235) in 302, colonoscopy with snare polyp removal (45385) in 294, and diagnostic colonoscopy (45378) in 280. Self-insured plans were the plan type in 2,436 disputes (80.3 percent). Nearly all were billed in covered settings: 1,845 disputes (60.85 percent) include a line at a surgery center, 666 (21.97 percent) at a hospital outpatient department, and 411 (13.56 percent) at a hospital inpatient unit, while 5 list a physician's office.
Sedation is where the volume sits
The 64,022 sedation disputes were 4.11 times the 15,589 of 2024. Arizona produced 20,379 (31.8 percent), Texas 11,401 (17.8), and Florida 7,728 (12.1), together 61.71 percent, and three filer domains brought 27,440 (42.86 percent). Screening colonoscopy anesthesia (00812) alone appeared in 28,711 disputes. Of the disputes, 38,618 (60.32 percent) include a line at a surgery center and 21,487 (33.56 percent) at a hospital outpatient department. Both sides pay a $15 administrative fee on each dispute, and the fee charged by the IDR entity is refunded to the winner. Lido IDR handles the dispute for a flat fee per arbitration and prices each offer from the decided results at idrexplorer.com.
Common questions
Can gastroenterology claims use federal IDR?
Yes, for out-of-network clinicians at an in-network surgery center, hospital outpatient department, or hospital. Anesthesia and pathology are ancillary services the patient cannot be asked to waive. A gastroenterologist's own scheduled care can fall outside the protection if the patient signs a notice and consent form, and a physician office is not a covered facility. Medicare, Medicare Advantage, Medicaid, and TRICARE claims are outside the process.
What do colonoscopy and endoscopy codes pay in federal IDR?
In the 2025 files, colonoscopy with biopsy (45380) had a median QPA of $330.59 and a median decided award of $18,000.00, and upper endoscopy with biopsy (43239) $212.12 and $15,000.00. Sedation for a screening colonoscopy (00812) had a median QPA of $247.22 and a median award of $1,620.00.
Why are gastroenterologist-filed disputes so few?
The 2025 files hold 1,446 disputes filed under a gastroenterology specialty, with 98.55 percent from California and New York and 96.75 percent from two filer domains. The count shows who files, not how many GI claims are underpaid.
How long does a gastroenterology dispute take to decide?
In the 2025 files the median dispute with a GI procedure code reached a decision in 28 days, against 40 days in 2024 and 60 in 2023, and the median sedation dispute took 31 days. Default decisions, where one side never submitted an offer, made up 13.56 percent of procedure disputes and 13.71 percent of sedation disputes.
What does filing cost a gastroenterology practice?
Each party pays a $15 administrative fee for every dispute and fronts the IDR entity's fee, which comes back to the winner. A billing partner that takes a share of the recovery costs more as awards grow. Lido IDR files for a flat fee per arbitration, which suits practices with a few high-value procedure claims or thousands of sedation lines.
Talk through your numbers
Book 30 minutes with an NSA/IDR specialist. Bring your payer mix and rough out-of-network claim volume, and we will walk through which claims are eligible, what similar providers are winning at IDR, and what a flat fee arrangement looks like. Three quick questions, then pick a time.
Which best describes you?
Roughly how many out-of-network claims does your group bill a month?
An estimate is fine.
Who works your out-of-network claims today?
Last step, then pick a time.
By booking a call you agree to our privacy policy. We use your answers only to prepare for the call and to follow up about it. Please do not include any patient information.
Pick a time
You will talk with an NSA/IDR specialist about your out-of-network claim volume, your payers, and what a flat fee arrangement looks like for your group.
Loading available times…
This page is for medical providers
If you got a surprise medical bill, you do not need a service like ours. The federal No Surprises Act protects you directly, and government help is free.
Start here: cms.gov/medical-bill-rights
No Surprises Help Desk: 1-800-985-3059