Federal IDR outcomes: Orthopedic surgery in California
In 2025 Q1–Q4, the provider or facility offer prevailed in 87.2% of 1,418 determined Federal IDR dispute line items for orthopedic surgery in California. The median prevailing offer was 44.68x the QPA (25th–75th percentile 18.88x–75.13x; n = 1,215). The median time to a decision was 27 business days (n = 1,418).
Determined line items
1,418
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
87.2%
n = 1,418 · 2025 Q1–Q4
Median days to decision
27
business days, from dispute initiation · n = 1,418 · 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 | 1,418 | 87.2% | 44.68x † | 18.88x–75.13x | 1,215 | 27 |
| 2024 Q1–Q4 | 304 | 91.4% | 31.00x † | 11.84x–61.82x | 219 | 45 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 1,734 | 87.9% | 41.88x † | 16.76x–74.28x | 1,446 | 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 |
|---|---|---|---|---|---|
| 29882 Repair of inside or outside knee joint cartilage using an endoscope | 168 | 87.5% | 53.38x † | 167 | 28 |
| 99283 Emergency department visit with low level of medical decision making | 50 | 86.0% | – | 9 | 53 |
| 99205 New patient office or other outpatient visit with a high level of medical decisi | 47 | 87.2% | 26.04x † | 47 | 27 |
| 99215 Established patient office or other outpatient visit with high level of medical | 44 | 86.4% | 34.29x † | 44 | 22.5 |
| 29888 Repair of anterior cruciate ligament of knee using an endoscope | 41 | 85.4% | 40.38x † | 40 | 31 |
| 29883 Repair of inside and outside knee joint cartilage using an endoscope | 37 | 83.8% | 46.79x † | 37 | 36 |
| 63047 Partial removal of spine bone with release of lower spinal cord and/or nerves, 1 | 37 | 91.9% | 59.83x † | 37 | 26 |
| 22856 Insertion of artificial upper spine disc, anterior approach | 36 | 80.6% | 45.47x † | 36 | 27 |
| 63030 Partial removal of spine bone with release of lower spinal cord or nerves and/or | 31 | 83.9% | 49.26x † | 31 | 24 |
| 22853 Insertion of cage or mesh device to spine bone and disc space during spine fusio | 30 | 93.3% | 106.09x † | 30 | 25.5 |
| 29881 Removal of knee cartilage using an endoscope | 30 | 73.3% | 52.28x † | 30 | 24 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in California · Orthopedic surgery in all states
FAQ
What is the Federal IDR provider win rate for orthopedic surgery in California?
In 2025 Q1–Q4, the provider or facility offer was selected in 87.2% of 1,418 determined dispute line items for orthopedic 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 orthopedic surgery in California?
In 2025 Q1–Q4, the median prevailing offer was 44.68x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 18.88x to 75.13x (n = 1,215 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 California?
In 2025 Q1–Q4, the median was 27 business days (n = 1,418 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).