Federal IDR outcomes: Vascular surgery
In 2025 Q1–Q4, the provider or facility offer prevailed in 86.4% of 8,438 determined Federal IDR dispute line items for vascular surgery. The median prevailing offer was 46.42x the QPA (25th–75th percentile 13.57x–92.87x; n = 7,945). The median time to a decision was 29 business days (n = 8,438).
Specialty group built from the CMS free-text specialty field; see the grouping rules.
Determined line items
8,438
2025 Q1–Q4 · 4 split decisions excluded
Provider win rate
86.4%
n = 8,438 · 2025 Q1–Q4
Median days to decision
29
business days, from dispute initiation · n = 8,438 · 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 | 8,438 | 86.4% | 46.42x † | 13.57x–92.87x | 7,945 | 29 |
| 2024 Q1–Q4 | 1,632 | 87.3% | 28.67x † | 6.80x–58.75x | 1,422 | 50 |
| 2023 Q1–Q4 | 233 | 85.8% | 23.19x † | 6.80x–42.09x | 224 | 72 |
| 2023 Q1–2025 Q4 | 10,303 | 86.5% | 43.06x † | 11.69x–89.82x | 9,591 | 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 | 3,497 | 87.7% | 58.42x † | 3,226 | 29 |
| New York | 2,049 | 78.6% | 34.63x † | 2,016 | 31 |
| California | 1,929 | 87.9% | 64.95x † | 1,924 | 25 |
| Wisconsin | 419 | 98.3% | 16.80x | 283 | 40 |
| Nevada | 339 | 92.0% | 64.36x † | 339 | 25 |
| Arizona | 95 | 95.8% | 57.06x † | 94 | 28 |
| Pennsylvania | 69 | 98.6% | – | 23 | 27 |
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 | 1,085 | 84.1% | 45.83x † | 1,071 | 27 |
| 36475 Destruction of first incompetent vein of arm or leg using radiofrequency and ima | 844 | 83.3% | 68.34x † | 831 | 29 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 757 | 79.9% | 33.57x † | 751 | 46 |
| 93970 Ultrasound study of arm or leg veins with compression and maneuvers | 432 | 87.3% | 86.41x † | 431 | 25 |
| 22558 Fusion of lower spine bone through abdomen with partial removal of disc | 365 | 87.4% | 46.36x † | 317 | 26 |
| 99231 Subsequent hospital care with straightforward or low level of medical decision m | 261 | 92.3% | 99.05x † | 261 | 28 |
| 22853 Insertion of cage or mesh device to spine bone and disc space during spine fusio | 234 | 88.9% | 429.18x † | 181 | 31 |
| 36476 Destruction of subsequent incompetent veins of arm or leg using radiofrequency a | 219 | 83.1% | 187.10x † | 214 | 28 |
| 99497 Advance care planning, first 30 minutes | 194 | 77.3% | 34.95x † | 189 | 35 |
| 36466 Injection of chemical agent into multiple incompetent veins of same leg using ul | 187 | 83.4% | 123.92x † | 186 | 33 |
| 22585 Fusion of spine bones through front of body with partial removal of disc, each a | 185 | 93.0% | 92.17x † | 163 | 28 |
| 93971 Ultrasound study of one arm or leg veins with compression and maneuvers | 184 | 83.2% | 95.46x † | 181 | 20.5 |
| 99291 Critical care, first 30-74 minutes | 159 | 86.2% | 19.59x | 157 | 27 |
| 99284 Emergency department visit with moderate level of medical decision making | 144 | 84.0% | 24.49x † | 135 | 29 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 129 | 88.4% | 16.58x | 128 | 32 |
| 76937 Ultrasonic guidance for blood vessel access | 119 | 84.0% | 249.05x † | 119 | 25 |
| 35221 Repair of blood vessel of abdomen | 112 | 92.9% | 16.20x | 92 | 34 |
| 99255 Hospital consultation with high level of medical decision making, if using time, | 107 | 71.0% | 29.77x † | 104 | 31 |
| 37799 Other procedure on blood vessel | 105 | 86.7% | 3.17x | 56 | 31 |
| 36465 Injection of chemical agent into single incompetent vein of leg using ultrasound | 101 | 84.2% | 88.86x † | 100 | 25 |
| 64483 Injection of anesthetic and/or steroid drug into sacral spine nerve root using i | 99 | 99.0% | 17.12x | 71 | 38 |
| 22845 Placement of stabilizing device to front, 2-3 spine bone segments | 93 | 89.2% | 166.72x † | 75 | 33 |
| 99222 Initial hospital care with straightforward or low-level medical decision making, | 78 | 92.3% | 33.54x † | 78 | 28.5 |
| 22857 Insertion of artificial disc between bones of lower spine, single space | 72 | 88.9% | 67.91x † | 67 | 25 |
| 62321 Injection of substance into middle or upper spine canal using imaging guidance | 71 | 100.0% | 12.77x | 55 | 42 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
FAQ
What is the Federal IDR provider win rate for vascular surgery?
In 2025 Q1–Q4, the provider or facility offer was selected in 86.4% of 8,438 determined dispute line items for vascular 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 vascular surgery?
In 2025 Q1–Q4, the median prevailing offer was 46.42x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 13.57x to 92.87x (n = 7,945 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 vascular surgery?
In 2025 Q1–Q4, the median was 29 business days (n = 8,438 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).