Federal IDR outcomes: Plastic and reconstructive surgery in New Jersey
In 2025 Q1–Q4, the provider or facility offer prevailed in 89.1% of 11,149 determined Federal IDR dispute line items for plastic and reconstructive surgery in New Jersey. The median prevailing offer was 24.13x the QPA (25th–75th percentile 9.05x–54.34x; n = 9,709). The median time to a decision was 36 business days (n = 11,149).
Determined line items
11,149
2025 Q1–Q4 · 26 split decisions excluded
Provider win rate
89.1%
n = 11,149 · 2025 Q1–Q4
Median days to decision
36
business days, from dispute initiation · n = 11,149 · 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 | 11,149 | 89.1% | 24.13x † | 9.05x–54.34x | 9,709 | 36 |
| 2024 Q1–Q4 | 7,491 | 88.2% | 22.40x † | 8.07x–49.33x | 6,625 | 43 |
| 2023 Q1–Q4 | 1,077 | 79.8% | 13.71x | 5.58x–34.41x | 1,061 | 70 |
| 2023 Q1–2025 Q4 | 19,717 | 88.2% | 22.58x † | 8.18x–51.12x | 17,395 | 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 |
|---|---|---|---|---|---|
| 19318 Breast reduction | 715 | 86.3% | 47.04x † | 582 | 31 |
| 99283 Emergency department visit with low level of medical decision making | 606 | 90.3% | 14.56x | 578 | 51 |
| 13131 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, g | 560 | 91.4% | 44.44x † | 517 | 41 |
| 19357 Reconstruction of breast using tissue expander | 447 | 85.5% | 21.34x † | 416 | 35 |
| 19364 Reconstruction of breast with tissue graft | 443 | 92.1% | 21.08x † | 380 | 39 |
| 14301 Repair of wound by transferring skin, 30.1-60.0 sq cm | 407 | 85.3% | 27.72x † | 376 | 34 |
| 15734 Creation of muscle graft to trunk | 371 | 85.7% | 27.50x † | 303 | 34 |
| 14302 Repair of wound by transferring skin, each additional 30.0 sq cm | 353 | 83.9% | 25.01x † | 309 | 32 |
| 19380 Surgical change to reconstructed breast | 331 | 88.5% | 36.88x † | 295 | 36 |
| 13151 Complicated repair of wound of eyelids, nose, ears, or lip, 1.1-2.5 cm | 325 | 90.8% | 42.52x † | 306 | 38 |
| 15777 Implantation of biologic implant to soft tissue | 308 | 89.3% | 36.48x † | 283 | 38 |
| 13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, g | 241 | 90.0% | 33.48x † | 212 | 36 |
| 64905 Transfer of nerve to injured nerve, stage 1 of 2 | 207 | 91.3% | 40.42x † | 170 | 44 |
| 13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm | 205 | 87.8% | 49.97x † | 179 | 42 |
| 19371 Removal of capsule around breast implant | 165 | 90.9% | 47.83x † | 137 | 38 |
| 38530 Biopsy or removal of lymph nodes of breast | 148 | 89.9% | 67.88x † | 135 | 34.5 |
| 15771 Graft using patient's fat removed by liposuction and inserted into trunk, breast | 143 | 93.0% | 19.16x | 128 | 40 |
| 15002 Preparation of skin graft site of trunk, arms, or legs, 100.0 sq cm or 1% body a | 135 | 91.1% | 25.75x † | 121 | 34 |
| 15772 Graft using patient's fat removed by liposuction and inserted into trunk, breast | 134 | 95.5% | 32.65x † | 115 | 34 |
| 19342 Placement of implant on separate day of breast reconstruction | 131 | 93.9% | 20.68x † | 114 | 36 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in New Jersey · Plastic and reconstructive surgery in all states
FAQ
What is the Federal IDR provider win rate for plastic and reconstructive surgery in New Jersey?
In 2025 Q1–Q4, the provider or facility offer was selected in 89.1% of 11,149 determined dispute line items for plastic and reconstructive surgery in New Jersey. 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 New Jersey?
In 2025 Q1–Q4, the median prevailing offer was 24.13x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 9.05x to 54.34x (n = 9,709 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 New Jersey?
In 2025 Q1–Q4, the median was 36 business days (n = 11,149 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).