Neurology and neuromuscular procedures generated the highest payout multiple of any high-volume specialty in the federal No Surprises Act dispute resolution process during the third and fourth quarters of 2025, according to CMS data.
Here are three things to know:
1. Neurology and neuromuscular procedures led all major specialties in both quarters. Disputes involving CPT codes 95700-96020 had a median prevailing offer of 2,394% of the qualifying payment amount in Q3 of 2025 and 2,585% of QPA in Q4 of 2025, meaning arbitrators awarded providers roughly 24 to 26 times the insurer’s in-network benchmark rate. The category covered 34,396 determinations in Q3 and 32,145 in Q4.
2. Surgery was the next-highest major specialty. Surgical disputes had a median prevailing offer of 1,449% of QPA in Q3 and 1,503% in Q4, across approximately 53,000 to 56,000 determinations each quarter.
3. A health cost containment attorney previously flagged neuromonitoring, a subset of the neurology and neuromuscular category, as a problem area.
“Neuromonitoring is one particularly problematic area” in the dispute resolution process, Brian O’Hara, senior attorney for provider relations at the Phia Group, a health cost containment consultant, said in a Clear Health Costs article. He described the IDR process overall as “absolutely in shambles right now.”
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