CPT 27435: Federal IDR outcomes
Incision of back portion of knee joint capsule
In 2023 Q1–2025 Q4, the provider or facility offer prevailed in 88.9% of 36 determined Federal IDR dispute line items for CPT 27435. The median prevailing offer was 11.31x the QPA (25th–75th percentile 7.12x–15.32x; n = 34).
Determined line items
36
2023 Q1–2025 Q4 · 0 split decisions excluded
Provider win rate
88.9%
n = 36 · 2023 Q1–2025 Q4
Median payment vs QPA
11.31x
middle half 7.12x–15.32x · n = 34 · 2023 Q1–2025 Q4
Median days to decision
–
not pooled across years (CMS changed the definition in 2025)
Dollar amounts
Fewer than 30 line items with dollar amounts in 2024 Q3–2025 Q4; not shown.
Dollar amounts by period
| Period | Line items with $ | Total awarded | Total QPA | Above QPA | Median award | Median QPA | Award ×QPA ($-weighted) |
|---|---|---|---|---|---|---|---|
| 2025 Q1–Q4 | Fewer than 30 line items with dollar amounts; not shown. | ||||||
| 2024 Q3–Q4 | Fewer than 30 line items with dollar amounts; not shown. | ||||||
| 2024 Q3–2025 Q4 | Fewer than 30 line items with dollar amounts; not shown. | ||||||
| 2023 Q1–2024 Q2 | Not available (see methodology). | ||||||
From the CMS QPA and Offers file (see above). Award ×QPA here is total awarded ÷ total QPA, so large claims weigh more than in the per-line median ratio.
By period
| Period | Line items | Win % | Median ×QPA | 25th–75th | Ratio n | Median days |
|---|---|---|---|---|---|---|
| 2025 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2024 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 36 | 88.9% | 11.31x | 7.12x–15.32x | 34 | not pooled |
Line items = determined dispute line items (n). Win rate excludes split decisions and includes default decisions. Ratio n = line items reporting a payment-to-QPA ratio. Days are business days as reported by CMS (2023–2024: from IDR entity assignment; 2025: from initiation) and are never pooled.
By state
No row has 30 or more determined line items in 2025 Q1–Q4.
By specialty
No row has 30 or more determined line items in 2025 Q1–Q4.
Section: Surgery (10004–69990)
FAQ
What is the Federal IDR provider win rate for CPT 27435?
In 2023 Q1–2025 Q4, the provider or facility offer was selected in 88.9% of 36 determined dispute line items for CPT 27435. Split decisions are excluded from the denominator and default decisions are included. Withdrawn, settled and ineligible disputes are not in the CMS data.
How do Federal IDR payments compare with the QPA for CPT 27435?
In 2023 Q1–2025 Q4, the median prevailing offer was 11.31x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 7.12x to 15.32x (n = 34 line items). This uses the CMS field Prevailing Party Offer as % of QPA, where 1.00x equals the QPA.