Federal IDR outcomes: Neurosurgery and spine surgery
In 2025 Q1–Q4, the provider or facility offer prevailed in 88.2% of 29,793 determined Federal IDR dispute line items for neurosurgery and spine surgery. The median prevailing offer was 44.75x the QPA (25th–75th percentile 15.03x–111.39x; n = 26,882). The median time to a decision was 33 business days (n = 29,793).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
29,793
2025 Q1–Q4 · 30 split decisions excluded
Provider win rate
88.2%
n = 29,793 · 2025 Q1–Q4
Median days to decision
33
business days, from dispute initiation · n = 29,793 · 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 | 29,793 | 88.2% | 44.75x † | 15.03x–111.39x | 26,882 | 33 |
| 2024 Q1–Q4 | 10,912 | 87.7% | 32.04x † | 10.99x–75.33x | 9,577 | 56 |
| 2023 Q1–Q4 | 1,306 | 82.8% | 21.29x † | 5.73x–51.37x | 1,193 | 57 |
| 2023 Q1–2025 Q4 | 42,011 | 87.9% | 40.13x † | 13.15x–98.51x | 37,652 | 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 | 15,056 | 88.2% | 51.81x † | 13,195 | 34 |
| New York | 6,547 | 87.6% | 33.44x † | 5,899 | 35 |
| California | 4,302 | 85.8% | 56.67x † | 4,216 | 28 |
| Wisconsin | 2,449 | 94.4% | 23.84x † | 2,225 | 43 |
| Arizona | 403 | 89.6% | 126.12x † | 390 | 22 |
| Texas | 299 | 90.3% | 88.68x † | 284 | 32 |
| Florida | 289 | 88.6% | 75.21x † | 262 | 30 |
| Pennsylvania | 117 | 83.8% | 61.10x † | 112 | 34 |
| Washington | 105 | 83.8% | 61.38x † | 105 | 26 |
| Missouri | 63 | 79.4% | 54.73x † | 62 | 24 |
| Connecticut | 59 | 93.2% | 27.21x † | 53 | 129 |
| Ohio | 37 | 83.8% | 48.36x † | 35 | 24 |
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 |
|---|---|---|---|---|---|
| 22853 Insertion of cage or mesh device to spine bone and disc space during spine fusio | 2,135 | 87.1% | 102.06x † | 1,918 | 34 |
| 63047 Partial removal of spine bone with release of lower spinal cord and/or nerves, 1 | 1,091 | 87.1% | 49.66x † | 1,005 | 32 |
| 22551 Fusion of upper spine bone with removal of disc and release of spinal cord or ne | 975 | 86.2% | 31.92x † | 879 | 32 |
| 63048 Partial removal of spine bone with release of spinal cord and/or nerves, each ad | 974 | 85.3% | 62.40x † | 864 | 33 |
| 22614 Fusion of additional segment of spine | 804 | 86.6% | 40.93x † | 734 | 34 |
| 63030 Partial removal of spine bone with release of lower spinal cord or nerves and/or | 765 | 86.3% | 41.42x † | 724 | 30 |
| 22845 Placement of stabilizing device to front, 2-3 spine bone segments | 758 | 86.7% | 40.94x † | 676 | 31 |
| 22552 Fusion of upper spine bone with removal of disc and release of spinal cord or ne | 703 | 87.3% | 65.93x † | 629 | 34 |
| 22840 Placement of stabilizing device to back of 1 spine bone in neck | 658 | 86.5% | 41.09x † | 607 | 31 |
| 22842 Placement of stabilizing device to back, 3-6 spine bone segments | 655 | 86.9% | 38.68x † | 612 | 32 |
| 64483 Injection of anesthetic and/or steroid drug into sacral spine nerve root using i | 615 | 91.4% | 49.34x † | 588 | 33 |
| 22612 Fusion of spine in lower back | 590 | 84.7% | 39.08x † | 548 | 30 |
| 69990 Use of operating microscope | 539 | 90.2% | 25.91x † | 380 | 34 |
| 22633 Fusion of spine in lower back with partial removal of spine bone and disc | 526 | 86.9% | 31.14x † | 482 | 32 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 519 | 87.3% | 59.30x † | 512 | 36 |
| 64493 Injection of lower or sacral spine facet joint using imaging guidance, single le | 480 | 86.9% | 54.98x † | 465 | 32 |
| 64484 Injection of anesthetic and/or steroid drug into sacral spine nerve root using i | 470 | 92.3% | 78.28x † | 445 | 32.5 |
| 63052 Partial removal of bone of single segment of spine in lower back with release of | 465 | 88.4% | 218.46x † | 415 | 35 |
| 64494 Injection of lower or sacral spine facet joint using imaging guidance, second le | 441 | 87.1% | 89.07x † | 404 | 33 |
| 36224 Insertion of tube into internal neck artery for diagnosis or treatment with revi | 387 | 91.5% | 76.17x † | 359 | 37 |
| 64490 Injection of upper or middle spine facet joint using imaging guidance, single le | 387 | 89.4% | 47.51x † | 379 | 34 |
| 22558 Fusion of lower spine bone through abdomen with partial removal of disc | 383 | 86.2% | 60.61x † | 360 | 29 |
| 20930 Placement of fragmented bone graft or material to spine to promote bone growth | 372 | 87.9% | 26.16x † | 226 | 32.5 |
| 22856 Insertion of artificial upper spine disc, anterior approach | 363 | 86.8% | 47.74x † | 349 | 30 |
| 64491 Injection of upper or middle spine facet joint using imaging guidance, second le | 361 | 90.9% | 84.48x † | 347 | 33 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for neurosurgery and spine surgery?
In 2025 Q1–Q4, the provider or facility offer was selected in 88.2% of 29,793 determined dispute line items for neurosurgery and spine 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 neurosurgery and spine surgery?
In 2025 Q1–Q4, the median prevailing offer was 44.75x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 15.03x to 111.39x (n = 26,882 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 neurosurgery and spine surgery?
In 2025 Q1–Q4, the median was 33 business days (n = 29,793 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).