Federal IDR outcomes: Plastic and reconstructive surgery in California
In 2025 Q1–Q4, the provider or facility offer prevailed in 87.4% of 1,534 determined Federal IDR dispute line items for plastic and reconstructive surgery in California. The median prevailing offer was 36.46x the QPA (25th–75th percentile 9.46x–87.50x; n = 1,403). The median time to a decision was 28 business days (n = 1,534).
Determined line items
1,534
2025 Q1–Q4 · 4 split decisions excluded
Provider win rate
87.4%
n = 1,534 · 2025 Q1–Q4
Median days to decision
28
business days, from dispute initiation · n = 1,534 · 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 | 1,534 | 87.4% | 36.46x † | 9.46x–87.50x | 1,403 | 28 |
| 2024 Q1–Q4 | 273 | 94.1% | 13.45x | 6.43x–37.55x | 265 | 45 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 1,820 | 88.5% | 30.91x † | 8.14x–77.98x | 1,681 | 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 |
|---|---|---|---|---|---|
| 14301 Repair of wound by transferring skin, 30.1-60.0 sq cm | 75 | 86.7% | 71.45x † | 65 | 31 |
| 99214 Established patient office or other outpatient visit with moderate level of deci | 68 | 85.3% | 35.91x † | 67 | 25 |
| 19318 Breast reduction | 48 | 85.4% | 52.08x † | 42 | 27.5 |
| 15734 Creation of muscle graft to trunk | 41 | 82.9% | 41.19x † | 37 | 32 |
| 14302 Repair of wound by transferring skin, each additional 30.0 sq cm | 40 | 80.0% | 58.43x † | 31 | 44 |
| 15771 Graft using patient's fat removed by liposuction and inserted into trunk, breast | 39 | 84.6% | 13.81x | 37 | 31 |
| 15772 Graft using patient's fat removed by liposuction and inserted into trunk, breast | 38 | 86.8% | 10.99x | 37 | 27 |
| 15777 Implantation of biologic implant to soft tissue | 34 | 85.3% | 162.25x † | 32 | 31 |
| 14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm | 30 | 96.7% | 70.29x † | 30 | 46.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in California · Plastic and reconstructive surgery in all states
FAQ
What is the Federal IDR provider win rate for plastic and reconstructive surgery in California?
In 2025 Q1–Q4, the provider or facility offer was selected in 87.4% of 1,534 determined dispute line items for plastic and reconstructive 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 plastic and reconstructive surgery in California?
In 2025 Q1–Q4, the median prevailing offer was 36.46x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 9.46x to 87.50x (n = 1,403 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 California?
In 2025 Q1–Q4, the median was 28 business days (n = 1,534 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).