CMS Updates No Surprises Act IDR Guidance

CMS issued updated federal Independent Dispute Resolution (IDR) guidance Oct. 29 implementing changes that will significantly affect how radiology practices and other providers batch and submit disputes under the No Surprises Act.

Among the most significant changes for radiology are new batching rules. The new framework identifies 27 radiology code-range groups that may be used to batch services provided to different patients, provided the services fall within the same specified code range. The ranges include diagnostic imaging, ultrasound, radiologic guidance, mammography, bone and joint studies, radiation oncology and nuclear medicine. The guidance also implements a 50-dispute-line-item limit for affected batches whose open negotiation periods begin on or after Nov. 1, 2026.

The guidance also updates cooling off requirements for some batched disputes. Under the new framework, certain payment determinations trigger a 30-business-day cooling off period before another dispute involving the same service and opposing party can be filed. Batched disputes with open negotiation periods beginning before Nov. 1 remain subject to the 90-calendar-day cooling off period, as do single and bundled disputes regardless of when their open negotiation periods begin.

The guidance allows for overlapping cooling off periods when a dispute for an item or service receives a payment determination after the date another dispute involving the same item or service with the same non-initiating party is initiated. Providers initiating IDR disputes will need to keep track of payment determination dates and cooling off periods to avoid submitting ineligible claims.

In addition, CMS is moving federal IDR administration to its new IDR Gateway. Beginning Nov. 13, organizations with Gateway accounts will be able to submit key IDR forms, track disputes and access notifications through the system.

For questions about the IDR guidance, contact Katie Keysor, ACR® Vice President of Economic Policy.