Federal IDR outcomes: General and other surgery in California
In 2025 Q1–Q4, the provider or facility offer prevailed in 87.6% of 3,536 determined Federal IDR dispute line items for general and other surgery in California. The median prevailing offer was 36.83x the QPA (25th–75th percentile 12.35x–69.12x; n = 3,505). The median time to a decision was 29 business days (n = 3,536).
Determined line items
3,536
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
87.6%
n = 3,536 · 2025 Q1–Q4
Median days to decision
29
business days, from dispute initiation · n = 3,536 · 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 | 3,536 | 87.6% | 36.83x † | 12.35x–69.12x | 3,505 | 29 |
| 2024 Q1–Q4 | 1,226 | 87.8% | 23.09x † | 9.53x–44.73x | 1,219 | 47 |
| 2023 Q1–Q4 | 78 | 97.4% | 5.60x | 4.37x–15.29x | 78 | 31 |
| 2023 Q1–2025 Q4 | 4,840 | 87.8% | 32.67x † | 10.67x–62.92x | 4,802 | 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 |
|---|---|---|---|---|---|
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 280 | 88.2% | 40.36x † | 280 | 33.5 |
| 99231 Subsequent hospital care with straightforward or low level of medical decision m | 254 | 89.8% | 50.08x † | 253 | 30 |
| 44970 Removal of appendix using an endoscope | 219 | 93.2% | 46.86x † | 219 | 28 |
| 47379 Other procedure on liver using an endoscope | 162 | 84.6% | 17.22x | 161 | 27 |
| 99222 Initial hospital care with straightforward or low-level medical decision making, | 146 | 88.4% | 30.29x † | 145 | 28 |
| 43281 Repair of hernia of muscle at esophagus and stomach using an endoscope | 122 | 86.1% | 37.27x † | 121 | 27.5 |
| 47562 Removal of gallbladder using an endoscope | 112 | 89.3% | 44.05x † | 112 | 29.5 |
| 43775 Partial removal of stomach for weight loss using an endoscope | 107 | 86.9% | 112.33x † | 105 | 27 |
| 11772 Complicated removal of cyst of tailbone | 98 | 83.7% | 24.26x † | 97 | 38 |
| 43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscop | 94 | 85.1% | 78.02x † | 92 | 26 |
| 49650 Repair of groin hernia using an endoscope | 82 | 86.6% | 64.77x † | 81 | 29 |
| 14301 Repair of wound by transferring skin, 30.1-60.0 sq cm | 69 | 82.6% | 10.22x | 69 | 37 |
| 14302 Repair of wound by transferring skin, each additional 30.0 sq cm | 69 | 82.6% | 8.79x | 69 | 38 |
| 64999 Other procedure on nervous system | 65 | 83.1% | 24.58x † | 60 | 28 |
| 37799 Other procedure on blood vessel | 63 | 90.5% | 24.38x † | 61 | 27 |
| 99284 Emergency department visit with moderate level of medical decision making | 58 | 89.7% | 20.58x † | 57 | 29.5 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 57 | 82.5% | 28.39x † | 57 | 26 |
| 43659 Other procedure on stomach using an endoscope | 52 | 86.5% | 18.27x | 52 | 27 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 49 | 89.8% | 43.83x † | 49 | 24 |
| 99283 Emergency department visit with low level of medical decision making | 47 | 89.4% | 13.99x | 47 | 27 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in California · General and other surgery in all states
FAQ
What is the Federal IDR provider win rate for general and other surgery in California?
In 2025 Q1–Q4, the provider or facility offer was selected in 87.6% of 3,536 determined dispute line items for general and other surgery in California. 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 California?
In 2025 Q1–Q4, the median prevailing offer was 36.83x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 12.35x to 69.12x (n = 3,505 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 California?
In 2025 Q1–Q4, the median was 29 business days (n = 3,536 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).