IDR for vein clinics: the vein procedure record
What ablation and sclerotherapy lines won in 2025, why the site of service decides eligibility, and where the filing map is still mostly empty.
Vein procedures post some of the widest gaps in federal IDR between what payers benchmark and what arbitrators award: radiofrequency ablation lines carried a median QPA of $571 and a median decided award of $43,500 in the 2025 files. Most of that volume traces to a handful of filers in one state. This site walks vein and vascular practices through the process and cites only the published record.
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. Radiofrequency ablation of an incompetent vein (code 36475) appears in 2,426 disputes in the 2025 files; providers won 82.2 percent of decided ones, and the median decided award was $43,500 against a median QPA of $571.24. Eligibility turns on the site of service: procedures at hospitals and ambulatory surgery centers can qualify, office procedures cannot.
The site of service decides everything
The No Surprises Act protects out-of-network care in two settings: emergencies, and non-emergency services at an in-network hospital, hospital outpatient department, or ambulatory surgery center. That list of facilities is closed. An office procedure room is not on it, so an ablation performed in the office has no federal arbitration pathway, no matter how the payer prices it. The same procedure performed at an ASC can qualify. For a vein practice, eligibility is less about the code and more about where the case was done.
What the 2025 record shows
The published 2025 files put hard numbers on vein work that reached arbitration. Radiofrequency ablation of an incompetent vein (36475) appeared in 2,426 disputes. Providers won 82.2 percent of the decisions, and the median decided award was $43,500 against a median QPA of $571.24, a multiple above 70. Ultrasound-guided foam sclerotherapy (36465) ran 799 disputes at an 84.4 percent win rate and a $41,500 median decided award against a $253.93 QPA. Tunneled venous access ports (36561) won 91.7 percent. Across the fuller 2023 through 2025 record, vascular surgery line items appear in 4,089 disputes with an 88.6 percent win rate and a $36,000 median decided award.
A lopsided map
Most of the published vein ablation volume traces to a small group of New Jersey practices and their billing agents. That concentration cuts two ways. It means the award record already exists: arbitrators in every state can see what decided ablation lines paid. It also means that in most of the country, vein practices with qualifying claims have simply never filed. The comparables are published; the filing competition is not there yet.
What filing costs a vein practice
Filing costs each party $15 in administrative fees, and the certified IDR entity holds a deposit of a few hundred dollars that goes back to the winning side. Representation is where the money goes: hand a $43,500 ablation award to a 15 to 25 percent contingency vendor and $6,500 to $10,800 of it goes to the vendor on every case. Lido IDR files for a flat fee per arbitration instead. Every statistic on this site comes from the CMS public use files, explorable at idrexplorer.com.
Common questions
Can vein clinics use federal IDR?
Yes, for the right claims. Out-of-network procedures performed at an in-network hospital, hospital outpatient department, or ambulatory surgery center can qualify under the No Surprises Act, and emergency vascular care always does. Procedures performed in an office setting cannot, because the statute does not treat an office as a facility.
What does federal IDR pay on vein ablation claims?
In the 2025 public use files, radiofrequency ablation lines (36475) paid a median decided award of $43,500 against a median QPA of $571.24, with providers winning 82.2 percent of decisions. Foam sclerotherapy lines (36465) paid a median of $41,500 against a $253.93 QPA.
Do office-based vein procedures qualify for IDR?
No. The No Surprises Act defines facilities as a closed list: hospitals, hospital outpatient departments, critical access hospitals, and ambulatory surgery centers. An office procedure room or office-based lab is not on the list, so non-emergency office procedures have no federal IDR pathway.
Can a patient consent form remove a vein procedure from IDR?
Sometimes. For a scheduled procedure at an in-network facility, a notice-and-consent waiver validly signed 72 hours or more before the case, backed by a good faith estimate and a real in-network alternative, moves the claim outside the process. A waiver is never valid for an emergency, and payers assert waivers far more often than they can produce the executed form.
What does it cost a vein practice to file?
Filing costs each party $15 per dispute, and the certified IDR entity charges a few hundred dollars that the winning side recovers. Contingency vendors charge 15 to 25 percent of awards, thousands of dollars at ablation sizes; Lido IDR charges a flat fee per arbitration.
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.
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