Federal IDR outcomes: General and other surgery
In 2025 Q1–Q4, the provider or facility offer prevailed in 88.0% of 39,251 determined Federal IDR dispute line items for general and other surgery. The median prevailing offer was 7.64x the QPA (25th–75th percentile 2.00x–27.17x; n = 35,846). The median time to a decision was 33 business days (n = 39,251).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
39,251
2025 Q1–Q4 · 46 split decisions excluded
Provider win rate
88.0%
n = 39,251 · 2025 Q1–Q4
Median payment vs QPA
7.64x
middle half 2.00x–27.17x · n = 35,846 · 2025 Q1–Q4
Median days to decision
33
business days, from dispute initiation · n = 39,251 · 2025 Q1–Q4
Dollar amounts are not shown for specialty groups: the CMS QPA and Offers file, the only source of dollar figures, has no specialty field. See methodology.
By period
| Period | Line items | Win % | Median ×QPA | 25th–75th | Ratio n | Median days |
|---|---|---|---|---|---|---|
| 2025 Q1–Q4 | 39,251 | 88.0% | 7.64x | 2.00x–27.17x | 35,846 | 33 |
| 2024 Q1–Q4 | 15,179 | 86.5% | 9.72x | 3.33x–21.55x | 13,693 | 55 |
| 2023 Q1–Q4 | 2,504 | 79.9% | 8.27x | 2.16x–18.59x | 2,373 | 64 |
| 2023 Q1–2025 Q4 | 56,934 | 87.3% | 8.25x | 2.17x–25.05x | 51,912 | 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
| State (place of service) | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| New Jersey | 11,052 | 86.4% | 18.41x | 10,361 | 33 |
| Oklahoma | 8,168 | 98.4% | 2.00x | 7,941 | 32 |
| New York | 5,410 | 86.2% | 20.68x † | 4,936 | 32 |
| Texas | 4,064 | 78.6% | 9.35x | 2,545 | 31 |
| Colorado | 3,890 | 86.7% | 5.22x | 3,811 | 49 |
| California | 3,536 | 87.6% | 36.83x † | 3,505 | 29 |
| Florida | 1,306 | 85.2% | 11.34x | 1,202 | 29 |
| Maryland | 655 | 78.2% | 8.27x | 474 | 31 |
| Arizona | 429 | 84.8% | 25.86x † | 425 | 28 |
| Nevada | 174 | 93.7% | 57.89x † | 174 | 27 |
| Kansas | 170 | 93.5% | 4.23x | 149 | 40.5 |
| Wisconsin | 107 | 94.4% | 5.61x | 78 | 53 |
| Utah | 73 | 86.3% | 2.09x | 72 | 36 |
| Georgia | 60 | 66.7% | 1.00x | 60 | 34 |
| Connecticut | 40 | 95.0% | 5.43x | 34 | 33 |
| Indiana | 35 | 97.1% | – | 1 | 75 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 2,940 | 85.3% | 9.23x | 2,910 | 46 |
| 44970 Removal of appendix using an endoscope | 1,937 | 86.2% | 24.62x † | 1,816 | 31 |
| 47562 Removal of gallbladder using an endoscope | 1,735 | 85.6% | 29.30x † | 1,629 | 34 |
| 99222 Initial hospital care with straightforward or low-level medical decision making, | 1,056 | 86.1% | 14.59x | 1,026 | 39 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 948 | 83.9% | 5.99x | 904 | 37.5 |
| 99285 Emergency department visit with high level of medical decision making | 890 | 89.8% | 2.30x | 805 | 32 |
| 47563 Removal of gallbladder with X-ray study of bile ducts using an endoscope | 883 | 86.9% | 23.70x † | 813 | 29 |
| 99284 Emergency department visit with moderate level of medical decision making | 774 | 87.7% | 6.71x | 734 | 34 |
| 99231 Subsequent hospital care with straightforward or low level of medical decision m | 663 | 86.4% | 26.09x † | 656 | 31 |
| 99291 Critical care, first 30-74 minutes | 650 | 89.1% | 6.36x | 625 | 41 |
| 49650 Repair of groin hernia using an endoscope | 533 | 87.4% | 41.75x † | 510 | 31 |
| 43775 Partial removal of stomach for weight loss using an endoscope | 522 | 89.3% | 25.03x † | 498 | 34 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 522 | 85.2% | 9.72x | 502 | 31 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 514 | 94.2% | 3.16x | 466 | 31 |
| 80053 Blood test, comprehensive group of blood chemicals | 413 | 98.1% | 1.14x | 398 | 32 |
| 99283 Emergency department visit with low level of medical decision making | 370 | 87.6% | 11.99x | 359 | 36 |
| 43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscop | 354 | 86.4% | 7.79x | 345 | 27 |
| 58662 Destruction or removal of ovary or growth of pelvis using an endoscope | 350 | 82.0% | 42.73x † | 304 | 27 |
| 43281 Repair of hernia of muscle at esophagus and stomach using an endoscope | 295 | 84.7% | 22.54x † | 286 | 29 |
| 99221 Initial hospital care with straightforward or low level of medical decision maki | 262 | 81.7% | 14.40x | 260 | 34 |
| 96375 Injection of additional new drug or substance into vein | 238 | 95.8% | 1.71x | 210 | 31.5 |
| 64488 Injection of local anesthetic for abdominal wall pain control on both sides usin | 233 | 88.4% | 16.29x | 224 | 28 |
| 14301 Repair of wound by transferring skin, 30.1-60.0 sq cm | 214 | 87.9% | 13.90x | 211 | 36 |
| 44180 Release of small bowel scar tissue using an endoscope | 211 | 93.8% | 24.37x † | 194 | 34 |
| 15734 Creation of muscle graft to trunk | 210 | 81.4% | 18.30x | 204 | 33 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for general and other surgery?
In 2025 Q1–Q4, the provider or facility offer was selected in 88.0% of 39,251 determined dispute line items for general and other surgery. 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 general and other surgery?
In 2025 Q1–Q4, the median prevailing offer was 7.64x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 2.00x to 27.17x (n = 35,846 line items). This uses the CMS field Prevailing Party Offer as % of QPA, where 1.00x equals the QPA.
How long do Federal IDR decisions take for general and other surgery?
In 2025 Q1–Q4, the median was 33 business days (n = 39,251 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).