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Federal IDR initiations by state, 2025-Q4
Texas accounted for 280,355 initiations, followed by Arizona (44,934) and Florida (40,377).
States marked with an asterisk have a specified state law or all-payer model that applies to certain out-of-network disputes. Batched disputes spanning several states are counted in each state, so the state sum exceeds the national total.
| State or territory | Total initiations | Share of the top state |
|---|---|---|
| Texas * | 280,355 | |
| Arizona | 44,934 | |
| Florida * | 40,377 | |
| California * | 38,053 | |
| New Jersey * | 37,151 | |
| Georgia * | 27,584 | |
| New York * | 27,232 | |
| Tennessee | 23,778 | |
| Indiana | 19,079 | |
| Louisiana | 17,992 | |
| Oklahoma | 15,583 | |
| Virginia * | 12,881 | |
| Ohio * | 11,857 | |
| Nevada * | 11,456 | |
| Missouri * | 10,597 | |
| Arkansas | 9,676 | |
| North Carolina | 7,521 | |
| Colorado * | 7,251 | |
| New Mexico * | 6,767 | |
| Illinois * | 6,106 | |
| South Carolina | 6,059 | |
| Alabama | 5,500 | |
| Mississippi | 5,405 | |
| Wisconsin | 4,783 | |
| Kansas | 4,671 | |
| Kentucky | 4,508 | |
| Michigan * | 4,443 | |
| Pennsylvania | 4,108 | |
| Connecticut * | 3,681 | |
| Maryland * | 2,942 | |
| Washington * | 2,794 | |
| Idaho | 2,775 | |
| Alaska | 2,290 | |
| Utah | 1,321 | |
| West Virginia | 1,261 | |
| South Dakota | 1,212 | |
| Massachusetts | 1,211 | |
| Delaware * | 1,019 | |
| Iowa | 871 | |
| Oregon | 802 | |
| Maine * | 735 | |
| Rhode Island | 550 | |
| Nebraska * | 420 | |
| New Hampshire * | 356 | |
| Wyoming | 338 | |
| Hawaii | 284 | |
| Washington DC | 221 | |
| Montana | 176 | |
| Minnesota | 165 | |
| North Dakota | 52 | |
| Vermont | 4 | |
| American Samoa | 2 | |
| Puerto Rico | 2 |
Source: CMS Federal IDR Supplemental Tables, reporting year 2025 (CMS reports page). Quarterly medians cannot be combined into a yearly median, so each quarter is shown separately.