Federal IDR outcomes: Plastic and reconstructive surgery in Arizona
In 2025 Q1–Q4, the provider or facility offer prevailed in 91.0% of 509 determined Federal IDR dispute line items for plastic and reconstructive surgery in Arizona. The median prevailing offer was 16.72x the QPA (25th–75th percentile 7.97x–35.89x; n = 480). The median time to a decision was 25 business days (n = 509).
Determined line items
509
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
91.0%
n = 509 · 2025 Q1–Q4
Median payment vs QPA
16.72x
middle half 7.97x–35.89x · n = 480 · 2025 Q1–Q4
Median days to decision
25
business days, from dispute initiation · n = 509 · 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 | 509 | 91.0% | 16.72x | 7.97x–35.89x | 480 | 25 |
| 2024 Q1–Q4 | 294 | 87.8% | 9.59x | 5.65x–19.14x | 270 | 30.5 |
| 2023 Q1–Q4 | 43 | 97.7% | 15.45x | 9.58x–24.28x | 43 | 36 |
| 2023 Q1–2025 Q4 | 846 | 90.2% | 14.49x | 7.12x–27.13x | 793 | 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.
Most disputed CPT codes
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 19371 Removal of capsule around breast implant | 54 | 87.0% | 24.71x † | 49 | 25 |
| 19342 Placement of implant on separate day of breast reconstruction | 49 | 93.9% | 18.15x | 47 | 27 |
| 19316 Repair for sagging of the breast | 41 | 95.1% | 7.56x | 41 | 28 |
| 15771 Graft using patient's fat removed by liposuction and inserted into trunk, breast | 36 | 88.9% | 28.12x † | 35 | 24.5 |
| 19340 Placement of implant on same day of breast reconstruction | 35 | 82.9% | 13.16x | 35 | 21 |
| 15772 Graft using patient's fat removed by liposuction and inserted into trunk, breast | 33 | 87.9% | 37.99x † | 32 | 22 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in Arizona · Plastic and reconstructive surgery in all states
FAQ
What is the Federal IDR provider win rate for plastic and reconstructive surgery in Arizona?
In 2025 Q1–Q4, the provider or facility offer was selected in 91.0% of 509 determined dispute line items for plastic and reconstructive surgery in Arizona. 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 plastic and reconstructive surgery in Arizona?
In 2025 Q1–Q4, the median prevailing offer was 16.72x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 7.97x to 35.89x (n = 480 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 plastic and reconstructive surgery in Arizona?
In 2025 Q1–Q4, the median was 25 business days (n = 509 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).