Federal IDR outcomes: Cardiothoracic and thoracic surgery in New York
In 2025 Q1–Q4, the provider or facility offer prevailed in 74.2% of 833 determined Federal IDR dispute line items for cardiothoracic and thoracic surgery in New York. The median prevailing offer was 39.45x the QPA (25th–75th percentile 1.41x–140.88x; n = 813). The median time to a decision was 33 business days (n = 833).
Determined line items
833
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
74.2%
n = 833 · 2025 Q1–Q4
Median days to decision
33
business days, from dispute initiation · n = 833 · 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 | 833 | 74.2% | 39.45x † | 1.41x–140.88x | 813 | 33 |
| 2024 Q1–Q4 | 173 | 92.5% | 45.72x † | 8.26x–81.17x | 166 | 62 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 1,008 | 77.3% | 40.79x † | 1.93x–123.51x | 981 | 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 |
|---|---|---|---|---|---|
| 99231 Subsequent hospital care with straightforward or low level of medical decision m | 369 | 66.4% | 81.17x † | 366 | 35 |
| 31622 Diagnostic exam of lung airway using an endoscope | 34 | 82.4% | 37.56x † | 34 | 31 |
| 64421 Injection of anesthetic agent and/or steroid into multiple rib nerves for region | 34 | 73.5% | – | 28 | 45 |
| 99221 Initial hospital care with straightforward or low level of medical decision maki | 33 | 51.5% | 32.56x † | 33 | 24 |
| 64420 Injection of anesthetic agent and/or steroid into rib nerve | 31 | 74.2% | 1.41x | 30 | 51 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in New York · Cardiothoracic and thoracic surgery in all states
FAQ
What is the Federal IDR provider win rate for cardiothoracic and thoracic surgery in New York?
In 2025 Q1–Q4, the provider or facility offer was selected in 74.2% of 833 determined dispute line items for cardiothoracic and thoracic surgery in New York. 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 cardiothoracic and thoracic surgery in New York?
In 2025 Q1–Q4, the median prevailing offer was 39.45x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.41x to 140.88x (n = 813 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 cardiothoracic and thoracic surgery in New York?
In 2025 Q1–Q4, the median was 33 business days (n = 833 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).