Federal IDR outcomes: Neurosurgery and spine surgery in California
In 2025 Q1–Q4, the provider or facility offer prevailed in 85.8% of 4,302 determined Federal IDR dispute line items for neurosurgery and spine surgery in California. The median prevailing offer was 56.67x the QPA (25th–75th percentile 18.48x–167.62x; n = 4,216). The median time to a decision was 28 business days (n = 4,302).
Determined line items
4,302
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
85.8%
n = 4,302 · 2025 Q1–Q4
Median days to decision
28
business days, from dispute initiation · n = 4,302 · 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 | 4,302 | 85.8% | 56.67x † | 18.48x–167.62x | 4,216 | 28 |
| 2024 Q1–Q4 | 508 | 85.4% | 43.74x † | 15.26x–96.70x | 497 | 34 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 4,815 | 85.8% | 54.63x † | 18.09x–158.29x | 4,718 | 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 |
|---|---|---|---|---|---|
| 22853 Insertion of cage or mesh device to spine bone and disc space during spine fusio | 285 | 82.5% | 127.46x † | 281 | 26 |
| 63047 Partial removal of spine bone with release of lower spinal cord and/or nerves, 1 | 211 | 84.8% | 65.65x † | 209 | 26 |
| 22856 Insertion of artificial upper spine disc, anterior approach | 198 | 87.4% | 55.34x † | 195 | 29 |
| 63030 Partial removal of spine bone with release of lower spinal cord or nerves and/or | 194 | 84.5% | 65.68x † | 190 | 27 |
| 22558 Fusion of lower spine bone through abdomen with partial removal of disc | 177 | 82.5% | 70.58x † | 174 | 30 |
| 22612 Fusion of spine in lower back | 150 | 80.0% | 46.21x † | 150 | 27 |
| 22840 Placement of stabilizing device to back of 1 spine bone in neck | 143 | 82.5% | 52.02x † | 143 | 25 |
| 99291 Critical care, first 30-74 minutes | 114 | 96.5% | 14.68x | 113 | 33 |
| 63048 Partial removal of spine bone with release of spinal cord and/or nerves, each ad | 113 | 85.0% | 138.42x † | 111 | 26 |
| 69990 Use of operating microscope | 105 | 89.5% | 49.20x † | 88 | 25 |
| 22899 Other procedure on spine | 103 | 87.4% | 13.89x | 95 | 30 |
| 22858 Insertion of artificial upper spine disc anterior approach | 101 | 88.1% | 74.40x † | 100 | 26 |
| 22845 Placement of stabilizing device to front, 2-3 spine bone segments | 99 | 78.8% | 53.99x † | 98 | 30 |
| 99292 Critical care, each additional 30 minutes | 98 | 98.0% | 15.72x | 97 | 35 |
| 22551 Fusion of upper spine bone with removal of disc and release of spinal cord or ne | 86 | 83.7% | 44.92x † | 84 | 28 |
| 22614 Fusion of additional segment of spine | 85 | 81.2% | 63.02x † | 85 | 27 |
| 99213 Established patient office or other outpatient visit with low level od decision | 77 | 84.4% | 82.07x † | 76 | 30 |
| 20930 Placement of fragmented bone graft or material to spine to promote bone growth | 72 | 83.3% | 40.84x † | 71 | 28 |
| 22857 Insertion of artificial disc between bones of lower spine, single space | 70 | 85.7% | 76.95x † | 67 | 29 |
| 22842 Placement of stabilizing device to back, 3-6 spine bone segments | 69 | 84.1% | 45.49x † | 69 | 24 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in California · Neurosurgery and spine surgery in all states
FAQ
What is the Federal IDR provider win rate for neurosurgery and spine surgery in California?
In 2025 Q1–Q4, the provider or facility offer was selected in 85.8% of 4,302 determined dispute line items for neurosurgery and spine 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 neurosurgery and spine surgery in California?
In 2025 Q1–Q4, the median prevailing offer was 56.67x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 18.48x to 167.62x (n = 4,216 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 California?
In 2025 Q1–Q4, the median was 28 business days (n = 4,302 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).