Our batching rules guide sets out the 50-item cap, the 30-business-day timing window, and the three permitted bases for batching qualified IDR items and services under the June 4, 2026 Federal IDR Operations final rule (91 FR 33949; 45 CFR 149.510(c)(4)). This page works through synthetic, hypothetical examples against that same text so the mechanics are concrete. Every example below uses invented dates, invented provider and payer names, and invented service codes; none describes an actual dispute, and this page gives no view on whether any batch, real or hypothetical, would be accepted.
A batch of qualified IDR items and services must satisfy all of the following at once (45 CFR 149.510(c)(4)):
Hypothetical: Clinic A furnishes an emergency-department visit for one patient on a single date, billing 6 separate line items under one claim form for that encounter -- an evaluation-and-management code, two imaging codes, and three lab codes. All 6 items were furnished on the same date, well under the 50-item cap, and share the "same patient encounter" basis (45 CFR 149.510(c)(4)(i), first basis). If the parties' open negotiation for all 6 items ran on the same schedule and ended within the required window, this hypothetical batch would satisfy the cap, the timing window, and one of the three bases as described in the rule -- it says nothing about whether the underlying claims themselves are otherwise eligible or what they are worth.
Hypothetical: Radiology Group B furnished 48 separate imaging studies to 48 different patients, all billed under the identical service code, all furnished within the same 30-business-day period. That is 48 items -- under the 50-item cap -- sharing the "same or comparable service code" basis rather than the patient-encounter basis, because the patients differ (45 CFR 149.510(c)(4)(i), second basis). If a 49th and 50th item furnished under the same code in the same window were added, the batch would sit exactly at the cap; a 51st item would need to be excluded from this batch rather than causing the entire 50-item batch to fail, per the rule's construction (45 CFR 149.510(c)(4); 91 FR 33949 at 34006).
Hypothetical: Facility C wants to batch 10 anesthesiology items. Nine were furnished within a single 30-business-day period. The tenth was furnished 45 business days before that window -- outside the 30-business-day timing requirement relative to the other nine (45 CFR 149.510(c)(4)(vii)(B)). Under the rule's construction, that tenth item does not share the timing basis with the rest of the batch and can be excluded on that ground; the remaining nine, if they otherwise qualify, are not automatically disqualified along with it (91 FR 33949 at 34005, describing exclusion of an out-of-window item rather than failure of the whole batch).
Hypothetical: Pathology Group D furnished a set of items to different patients under different, but related, Category I CPT codes within the same CPT section, as specified in Departments' guidance. Because pathology is one of the four specialties named in the rule (anesthesiology, radiology, pathology, and laboratory), those items can share the "same Category I CPT section" basis even though they are neither the same patient encounter nor the same exact service code (45 CFR 149.510(c)(4)(i), third basis; 91 FR 33949 at 34005-34006). A dermatology practice with the same fact pattern -- related but non-identical codes across different patients -- would not have this third basis available, because dermatology is not one of the four named specialties; it would need to satisfy the patient-encounter or same-code basis instead.
None of these hypotheticals addresses whether the underlying items were qualified IDR items or services in the first place (see our eligibility grounds guide for that separate question), what an appropriate offer would be, or whether the applicability date for the batching provisions in a given dispute has actually arrived. A certified IDR entity decides all of that case by case.
Trilatic is preparing an application to become a certified Federal IDR entity and is not accepting disputes. This guide states no outcome and gives no advice on offers or amounts. It is not legal advice. Published 2026-09-13; last checked against primary sources on 2026-09-13.
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