Federal IDR outcomes: Orthopedic surgery
In 2025 Q1–Q4, the provider or facility offer prevailed in 87.9% of 26,139 determined Federal IDR dispute line items for orthopedic surgery. The median prevailing offer was 26.55x the QPA (25th–75th percentile 8.55x–72.11x; n = 21,132). The median time to a decision was 34 business days (n = 26,139).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
26,139
2025 Q1–Q4 · 64 split decisions excluded
Provider win rate
87.9%
n = 26,139 · 2025 Q1–Q4
Median days to decision
34
business days, from dispute initiation · n = 26,139 · 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 | 26,139 | 87.9% | 26.55x † | 8.55x–72.11x | 21,132 | 34 |
| 2024 Q1–Q4 | 9,015 | 86.3% | 16.62x | 6.68x–45.00x | 7,119 | 54 |
| 2023 Q1–Q4 | 867 | 86.5% | 12.68x | 4.94x–41.10x | 812 | 61 |
| 2023 Q1–2025 Q4 | 36,021 | 87.4% | 22.82x † | 7.66x–64.50x | 29,063 | 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 | 15,444 | 87.8% | 18.80x | 12,169 | 36 |
| New York | 6,256 | 88.3% | 34.39x † | 4,972 | 34 |
| Texas | 1,577 | 88.0% | 29.84x † | 1,489 | 32 |
| California | 1,418 | 87.2% | 44.68x † | 1,215 | 27 |
| Florida | 428 | 82.7% | 65.51x † | 359 | 25 |
| Arizona | 354 | 90.1% | 208.63x † | 353 | 28 |
| Georgia | 194 | 95.4% | 181.11x † | 191 | 24 |
| Pennsylvania | 141 | 87.9% | 405.11x † | 136 | 17 |
| Maryland | 108 | 88.9% | 46.24x † | 108 | 32 |
| Colorado | 55 | 83.6% | 23.19x † | 52 | 23 |
| Maine | 50 | 84.0% | – | 2 | 39.5 |
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 |
|---|---|---|---|---|---|
| 29826 Shaving of part of shoulder bone and repair of ligament using an endoscope | 808 | 89.4% | 59.12x † | 647 | 33 |
| 22853 Insertion of cage or mesh device to spine bone and disc space during spine fusio | 735 | 85.7% | 94.12x † | 601 | 34 |
| 29827 Repair of shoulder rotator cuff using an endoscope | 605 | 87.6% | 22.93x † | 509 | 32 |
| 29881 Removal of knee cartilage using an endoscope | 587 | 91.7% | 26.63x † | 438 | 33 |
| 27447 Replacement of knee joint, both sides of knee | 547 | 86.8% | 12.55x | 477 | 31 |
| 29823 Removal of extensive shoulder joint tissue using an endoscope | 505 | 86.9% | 39.96x † | 350 | 30 |
| 63047 Partial removal of spine bone with release of lower spinal cord and/or nerves, 1 | 479 | 85.8% | 58.70x † | 400 | 30 |
| 99284 Emergency department visit with moderate level of medical decision making | 475 | 91.6% | 8.31x | 455 | 54 |
| 27130 Replacement of thigh bone and hip joint with prosthesis | 449 | 88.9% | 33.18x † | 399 | 30 |
| 29888 Repair of anterior cruciate ligament of knee using an endoscope | 440 | 86.8% | 29.39x † | 398 | 33 |
| 29882 Repair of inside or outside knee joint cartilage using an endoscope | 398 | 88.2% | 35.67x † | 344 | 31 |
| 99283 Emergency department visit with low level of medical decision making | 391 | 88.7% | 14.90x | 331 | 37 |
| 29876 Removal of joint lining from multiple knee joint compartments using an endoscope | 388 | 93.0% | 14.84x | 223 | 34 |
| 29824 Partial removal of collar bone at shoulder using an endoscope | 366 | 87.4% | 30.42x † | 304 | 34 |
| 63048 Partial removal of spine bone with release of spinal cord and/or nerves, each ad | 343 | 87.5% | 83.12x † | 262 | 34 |
| 22614 Fusion of additional segment of spine | 334 | 84.4% | 61.13x † | 263 | 37.5 |
| 22612 Fusion of spine in lower back | 333 | 84.1% | 39.56x † | 295 | 32 |
| 29828 Release of tendon connecting biceps muscle and shoulder using an endoscope | 331 | 88.8% | 31.48x † | 259 | 33 |
| 76000 Imaging guidance for procedure, 60 minutes or less | 328 | 86.3% | 58.22x † | 245 | 44.5 |
| 22845 Placement of stabilizing device to front, 2-3 spine bone segments | 326 | 83.7% | 39.29x † | 273 | 33 |
| 63030 Partial removal of spine bone with release of lower spinal cord or nerves and/or | 316 | 86.1% | 49.33x † | 278 | 34 |
| 22551 Fusion of upper spine bone with removal of disc and release of spinal cord or ne | 303 | 83.2% | 29.24x † | 255 | 32 |
| 29880 Removal of both knee cartilages using an endoscope | 277 | 89.9% | 23.23x † | 198 | 32 |
| 29879 Repair of knee joint with drilling and or scraping of joint using an endoscope | 264 | 90.5% | 19.03x | 207 | 35.5 |
| 22840 Placement of stabilizing device to back of 1 spine bone in neck | 257 | 83.3% | 41.78x † | 231 | 33 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for orthopedic surgery?
In 2025 Q1–Q4, the provider or facility offer was selected in 87.9% of 26,139 determined dispute line items for orthopedic 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 orthopedic surgery?
In 2025 Q1–Q4, the median prevailing offer was 26.55x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 8.55x to 72.11x (n = 21,132 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 orthopedic surgery?
In 2025 Q1–Q4, the median was 34 business days (n = 26,139 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).