24 procedures · Data from CMS, KFF & FOS

Insurance Denial Rate Lookup

Check the denial rate and appeal success rate for any medical procedure. Find your procedure below.

24 results
MRI Scan
ImagingUS
23%
denial rate
Denial Rate23%
Appeal Success61%
Top denial reason
Prior Authorization
Avg claim (USD)
$2,400
CT Scan
ImagingUS
18%
denial rate
Denial Rate18%
Appeal Success65%
Top denial reason
Medical Necessity
Avg claim (USD)
$1,800
Chemotherapy
Cancer TreatmentUS
31%
denial rate
Denial Rate31%
Appeal Success54%
Top denial reason
Experimental Treatment
Avg claim (USD)
$18,500
Mental Health Therapy
Behavioral HealthUS
28%
denial rate
Denial Rate28%
Appeal Success67%
Top denial reason
Medical Necessity
Avg claim (USD)
$890
ER Visit
EmergencyUS
15%
denial rate
Denial Rate15%
Appeal Success72%
Top denial reason
Out of Network
Avg claim (USD)
$4,200
Physical Therapy
RehabilitationUS
19%
denial rate
Denial Rate19%
Appeal Success63%
Top denial reason
Medical Necessity
Avg claim (USD)
$1,200
Fertility Treatment
Reproductive HealthUS
42%
denial rate
Denial Rate42%
Appeal Success48%
Top denial reason
Coverage Exclusion
Avg claim (USD)
$8,900
Surgery (General)
SurgeryUS
21%
denial rate
Denial Rate21%
Appeal Success59%
Top denial reason
Prior Authorization
Avg claim (USD)
$24,500
Prescription Drugs
PharmacyUS
16%
denial rate
Denial Rate16%
Appeal Success70%
Top denial reason
Step Therapy Required
Avg claim (USD)
$1,100
Home Health Care
Post-Acute CareUS
25%
denial rate
Denial Rate25%
Appeal Success58%
Top denial reason
Medical Necessity
Avg claim (USD)
$3,400
Dental Treatment
DentalUS
34%
denial rate
Denial Rate34%
Appeal Success52%
Top denial reason
Coverage Exclusion
Avg claim (USD)
$1,600
Vision Care
VisionUS
29%
denial rate
Denial Rate29%
Appeal Success55%
Top denial reason
Coverage Exclusion
Avg claim (USD)
$450
Sleep Study (PSG)
DiagnosticsUS
27%
denial rate
Denial Rate27%
Appeal Success67%
Top denial reason
Prior Authorization
Avg claim (USD)
$1,500
Spinal Fusion Surgery
SurgeryUS
31%
denial rate
Denial Rate31%
Appeal Success62%
Top denial reason
Medical Necessity
Avg claim (USD)
$50,000
Knee Replacement
SurgeryUS
23%
denial rate
Denial Rate23%
Appeal Success76%
Top denial reason
Medical Necessity
Avg claim (USD)
$35,000
Genetic Testing
DiagnosticsUS
41%
denial rate
Denial Rate41%
Appeal Success61%
Top denial reason
Experimental / Investigational
Avg claim (USD)
$3,000
Ambulance Transport
EmergencyUS
33%
denial rate
Denial Rate33%
Appeal Success69%
Top denial reason
Medical Necessity
Avg claim (USD)
$1,800
Bariatric Surgery
SurgeryUS
38%
denial rate
Denial Rate38%
Appeal Success66%
Top denial reason
Medical Necessity
Avg claim (USD)
$22,000
Hip Replacement
SurgeryUS
21%
denial rate
Denial Rate21%
Appeal Success74%
Top denial reason
Medical Necessity
Avg claim (USD)
$38,000
ICU Stay
InpatientUS
11%
denial rate
Denial Rate11%
Appeal Success84%
Top denial reason
Medical Necessity
Avg claim (USD)
$25,000
Private MRI (UK)
ImagingUK
19%
denial rate
Denial Rate19%
Appeal Success68%
Top denial reason
Medical Necessity
Avg claim (USD)
$900
Private Surgery (UK)
SurgeryUK
16%
denial rate
Denial Rate16%
Appeal Success71%
Top denial reason
Pre-existing Condition
Avg claim (USD)
$12,000
Hospital Admission (AU)
InpatientAU
14%
denial rate
Denial Rate14%
Appeal Success73%
Top denial reason
Waiting Period
Avg claim (USD)
$8,000
Dental (AU)
DentalAU
31%
denial rate
Denial Rate31%
Appeal Success57%
Top denial reason
Coverage Exclusion
Avg claim (USD)
$1,200
Data compiled from CMS Transparency in Coverage data, KFF analysis of marketplace plan data, AHIP utilization reports, and FOS (UK) claims data. Figures represent approximate averages and may vary by insurer, plan, and year. Last updated March 2026.

Frequently Asked Questions

Which medical procedure has the highest insurance denial rate?

Among common procedures, fertility treatments have the highest denial rate at approximately 42%, followed by genetic testing (41%), bariatric surgery (38%), and dental treatment (34%). Mental health therapy is also frequently denied at approximately 28%, often in violation of mental health parity laws. Denial rates vary by insurer and plan type.

What procedure has the highest appeal success rate?

ICU stays have the highest appeal success rate at approximately 84%, followed by emergency room visits (72%) and knee replacements (76%). These high success rates reflect the fact that denials for clearly medically necessary care are difficult for insurers to justify on appeal. Mental health therapy appeals also succeed at high rates (67%) due to mental health parity laws.

Where does this denial rate data come from?

The denial rate data in the ClaimBack Denial Rate Lookup is compiled from CMS Transparency in Coverage data, KFF (Kaiser Family Foundation) analysis of marketplace plan data, AHIP utilization reports, and peer-reviewed health policy research. Figures represent approximate averages across US commercial plans and may vary by insurer, plan type, and year.

Related Tools & Guides

How to Appeal (Step by Step) →Top Denial Reasons →Deadline Calculator →Denial Report 2026 →Statistics →

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