Federal IDR outcomes: Plastic and reconstructive surgery in Massachusetts
In 2025 Q1–Q4, the provider or facility offer prevailed in 88.5% of 555 determined Federal IDR dispute line items for plastic and reconstructive surgery in Massachusetts. The median prevailing offer was 15.06x the QPA (25th–75th percentile 11.86x–18.88x; n = 539). The median time to a decision was 38 business days (n = 555).
Determined line items
555
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
88.5%
n = 555 · 2025 Q1–Q4
Median payment vs QPA
15.06x
middle half 11.86x–18.88x · n = 539 · 2025 Q1–Q4
Median days to decision
38
business days, from dispute initiation · n = 555 · 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 | 555 | 88.5% | 15.06x | 11.86x–18.88x | 539 | 38 |
| 2024 Q1–Q4 | 230 | 86.5% | 15.56x | 10.23x–17.42x | 230 | 100 |
| 2023 Q1–Q4 | 158 | 76.6% | 15.77x | 6.37x–17.32x | 158 | 71 |
| 2023 Q1–2025 Q4 | 943 | 86.0% | 15.26x | 10.68x–18.19x | 927 | 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 |
|---|---|---|---|---|---|
| 99283 Emergency department visit with low level of medical decision making | 37 | 94.6% | 14.63x | 37 | 49 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in Massachusetts · Plastic and reconstructive surgery in all states
FAQ
What is the Federal IDR provider win rate for plastic and reconstructive surgery in Massachusetts?
In 2025 Q1–Q4, the provider or facility offer was selected in 88.5% of 555 determined dispute line items for plastic and reconstructive surgery in Massachusetts. 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 Withdrawn, settled and ineligible disputes are not in the CMS data.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 Massachusetts?
In 2025 Q1–Q4, the median prevailing offer was 15.06x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 11.86x to 18.88x (n = 539 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 Massachusetts?
In 2025 Q1–Q4, the median was 38 business days (n = 555 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).