Can federal IDR disputes be batched?
Verdict Consulting Group Research · Updated
Answer
Yes. Multiple qualified IDR items and services can be decided in one batched determination. Under the 2026 Federal IDR Operations rule, for disputes whose open negotiation period begins on or after November 1, 2026, a batch may hold up to 50 line items and must fit one of three categories the rule defines.
Detail
The three batching categories
| Category | What can be batched together |
|---|---|
| Patient encounter | Services for one patient on the same or consecutive dates of service, billed on the same claim form |
| Same service code | Services for one or more patients under the same service code, or a comparable code in a different code system (for example, CPT and HCPCS) |
| Specialty code sections | Anesthesiology, radiology, pathology and laboratory services under codes in the same Category I CPT code section, as specified in guidance |
All batched items must also be billed by the same provider, group of providers, facility or air ambulance provider, and paid by the same plan or issuer, as the statute requires (42 U.S.C. 300gg-111(c)(3)).
Timing and limits
CMS's August 7, 2026 guide states that all batching provisions of the rule, including the 50-line-item limit and the cooling-off period for batched disputes, apply to disputes with open negotiation periods starting on or after November 1, 2026. Batched determinations carry the batched certified IDR entity fee, plus a tiered fee for each additional 25 line items.
The rule replaces batching provisions that a federal court vacated in August 2023 in Texas Medical Association v. HHS (E.D. Tex. No. 6:23-cv-59).
Read the analysis
Sources
- Centers for Medicare & Medicaid Services — Federal IDR Operations Final Rules Implementation Timeline Guide ()
- Centers for Medicare & Medicaid Services — Federal Independent Dispute Resolution Operations Final Rule — Fact Sheet ()
- Electronic Code of Federal Regulations — 45 CFR 149.510 — Independent dispute resolution process ()
General information only, not legal advice. Verdict Consulting Group is not a law firm.