IDR for air ambulance: the air medical record
What helicopter and fixed-wing transports won in 2025, how base rate and mileage lines get filed, and why the federal process applies in every state.
Air ambulance has its own table in the federal IDR files, and the 2025 numbers are large: 44,087 disputes, up from 31,944 a year earlier, with providers winning 91.81 percent at a median of 2.45 times the QPA. Three operators filed 84.45 percent of them, and 52 other filer domains share the rest. This site explains how the process works for air medical claims, using the CMS files and nothing else.
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. Air ambulance transports have their own table in the 2025 files: 44,087 disputes, a 91.81 percent provider win rate, and decisions at a median of 2.45 times the QPA. The federal process applies to air ambulance claims in every state, and the statute adds air-specific factors, such as aircraft type and pickup location, to what the arbitrator weighs.
Bigger, faster, and more lopsided every year
The air ambulance files grew from 11,467 disputes in 2023 to 31,944 in 2024 and 44,087 in 2025. Over the same stretch the provider win rate rose from 85.39 to 91.81 percent, default decisions fell from 24.2 to 15.84 percent of disputes, and the median time to a decision dropped from 65 days to 33. The median payer offer moved up from 1.0 to 1.2 times the QPA, while the median decided award held between 2.41 and 2.53 times.
Four codes carry the money
Nearly every dispute is about one of four billing codes: a base rate for the flight (A0431 for helicopters, A0430 for fixed-wing aircraft) and a mileage charge per statute mile (A0436 and A0435). Helicopters account for 86.12 percent of disputes. A helicopter base line had a median QPA of $14,917.16 and a median decided award of $36,484; the mileage line, $6,024.94 and $19,000. Counting lines that report a QPA and offers, provider wins on the four codes add up to $1,136.2 million in prevailing offers for 2025, against $650.8 million in 2024.
Three operators file most of them
The three largest operators filed 25,099, 7,831, and 4,301 of the 2025 disputes, 84.45 percent together, and won between 91.9 and 94.9 percent of them. The third-largest operator stands apart on price, with decided awards at a median of 5.44 times the QPA against 2.33 and 2.21 for the other two. The other 52 filer domains brought 6,856 disputes, won 86.61 percent, and waited a median of 39 days for a decision against 32 for the large three.
Payers, states, and filing costs
Providers won 98.2 percent of 8,209 disputes against Centene plans and 97.6 percent of 5,485 against Blue Cross Blue Shield of Texas. Kaiser Permanente is the low outlier at 54.5 percent. Texas holds 8,773 disputes, while Florida and New Mexico decided at 6.83 and 5.81 times the QPA. Each side pays a $15 administrative fee on every dispute, and the IDR entity deposit is returned to the winner. Lido IDR takes on the filing for a flat fee per arbitration, with each offer priced from decided air ambulance awards at idrexplorer.com.
Common questions
Can air ambulance operators use federal IDR?
Yes. The No Surprises Act protects patients on commercial plans from balance bills for air transports and sends payment disputes with out-of-network operators to federal IDR. Self-funded employer plans, individual-market plans, fully insured group plans, and federal employee plans all appear in the 2025 files. Medicare, Medicaid, and TRICARE claims do not qualify.
What do air ambulance claims pay in federal IDR?
Providers won 91.81 percent of the 44,087 air ambulance disputes in the 2025 files, at a median of 2.45 times the QPA. Helicopter base lines (A0431) paid a median decided award of $36,484 against a $14,917.16 median QPA, and helicopter mileage lines (A0436) paid $19,000 against $6,024.94.
Do state laws apply to air ambulance claims?
Generally not. The Airline Deregulation Act bars states from regulating air carrier prices and services, and the federal rules treat that limit as covering air ambulance operators, so the No Surprises Act process applies to commercial plans in every state.
Can the base rate and mileage be disputed together?
Yes. Since the August 2023 TMA III court order, CMS guidance has allowed the base rate and mileage codes of one transport to be filed as a batched dispute, and either code can still be filed alone. In 2025, 9,740 disputes carried both codes.
What does it cost an air ambulance operator to file?
Each side owes a $15 administrative fee on every dispute, and the certified IDR entity charges a deposit that goes back to the winner. Vendors paid on commission typically keep 15 to 25 percent of the recovery; Lido IDR files for a flat fee per arbitration.
Talk through your numbers
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