Federal IDR outcomes: Plastic and reconstructive surgery in Florida
In 2025 Q1–Q4, the provider or facility offer prevailed in 95.3% of 2,077 determined Federal IDR dispute line items for plastic and reconstructive surgery in Florida. The median prevailing offer was 12.42x the QPA (25th–75th percentile 6.54x–22.75x; n = 1,756). The median time to a decision was 35 business days (n = 2,077).
Determined line items
2,077
2025 Q1–Q4 · 2 split decisions excluded
Provider win rate
95.3%
n = 2,077 · 2025 Q1–Q4
Median payment vs QPA
12.42x
middle half 6.54x–22.75x · n = 1,756 · 2025 Q1–Q4
Median days to decision
35
business days, from dispute initiation · n = 2,077 · 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 | 2,077 | 95.3% | 12.42x | 6.54x–22.75x | 1,756 | 35 |
| 2024 Q1–Q4 | 954 | 93.6% | 10.27x | 4.89x–19.61x | 853 | 49.5 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 3,053 | 94.6% | 11.66x | 5.94x–21.48x | 2,631 | 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 |
|---|---|---|---|---|---|
| 15777 Implantation of biologic implant to soft tissue | 78 | 94.9% | 14.82x | 75 | 31 |
| 19357 Reconstruction of breast using tissue expander | 72 | 90.3% | 11.53x | 70 | 34.5 |
| 14301 Repair of wound by transferring skin, 30.1-60.0 sq cm | 65 | 92.3% | 11.15x | 64 | 31 |
| 15738 Creation of muscle graft to leg | 55 | 92.7% | 24.76x † | 52 | 44 |
| 19318 Breast reduction | 54 | 81.5% | 15.42x | 45 | 23 |
| 15734 Creation of muscle graft to trunk | 51 | 86.3% | 13.66x | 46 | 61 |
| 19380 Surgical change to reconstructed breast | 49 | 98.0% | 71.01x † | 49 | 27 |
| 11970 Replacement of tissue expander with permanent implant | 47 | 100.0% | 25.76x † | 42 | 31 |
| 14302 Repair of wound by transferring skin, each additional 30.0 sq cm | 41 | 95.1% | 7.64x | 41 | 29 |
| 15771 Graft using patient's fat removed by liposuction and inserted into trunk, breast | 40 | 92.5% | 16.07x | 39 | 32 |
| 11012 Removal of foreign material from skin, tissue, muscle, and bone at open broken a | 38 | 94.7% | – | 29 | 55 |
| 15772 Graft using patient's fat removed by liposuction and inserted into trunk, breast | 37 | 97.3% | 18.31x | 37 | 27 |
| 99284 Emergency department visit with moderate level of medical decision making | 37 | 100.0% | – | 18 | 39 |
| 11043 Removal of muscle and/or tissue, 20.0 sq cm or less | 32 | 96.9% | – | 27 | 63.5 |
| 15100 Partial thickness self skin graft to trunk, arms, or legs, 100.0 sq cm or 1% bod | 30 | 96.7% | – | 28 | 42 |
| 19342 Placement of implant on separate day of breast reconstruction | 30 | 96.7% | – | 29 | 31 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in Florida · Plastic and reconstructive surgery in all states
FAQ
What is the Federal IDR provider win rate for plastic and reconstructive surgery in Florida?
In 2025 Q1–Q4, the provider or facility offer was selected in 95.3% of 2,077 determined dispute line items for plastic and reconstructive surgery in Florida. 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 Florida?
In 2025 Q1–Q4, the median prevailing offer was 12.42x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 6.54x to 22.75x (n = 1,756 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 Florida?
In 2025 Q1–Q4, the median was 35 business days (n = 2,077 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).