Federal IDR outcomes: General and other surgery in New York
In 2025 Q1–Q4, the provider or facility offer prevailed in 86.2% of 5,410 determined Federal IDR dispute line items for general and other surgery in New York. The median prevailing offer was 20.68x the QPA (25th–75th percentile 6.70x–51.42x; n = 4,936). The median time to a decision was 32 business days (n = 5,410).
Determined line items
5,410
2025 Q1–Q4 · 4 split decisions excluded
Provider win rate
86.2%
n = 5,410 · 2025 Q1–Q4
Median days to decision
32
business days, from dispute initiation · n = 5,410 · 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 | 5,410 | 86.2% | 20.68x † | 6.70x–51.42x | 4,936 | 32 |
| 2024 Q1–Q4 | 2,656 | 84.3% | 16.10x | 4.74x–42.37x | 2,222 | 63 |
| 2023 Q1–Q4 | 597 | 86.4% | 12.81x | 2.75x–46.88x | 546 | 75 |
| 2023 Q1–2025 Q4 | 8,663 | 85.6% | 18.88x | 5.65x–48.59x | 7,704 | 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 |
|---|---|---|---|---|---|
| 47562 Removal of gallbladder using an endoscope | 438 | 87.4% | 33.87x † | 395 | 34 |
| 44970 Removal of appendix using an endoscope | 360 | 86.7% | 35.75x † | 332 | 33 |
| 99233 Subsequent hospital care with moderate levelof medical decision making, if using | 260 | 81.2% | 12.05x | 248 | 37 |
| 49650 Repair of groin hernia using an endoscope | 212 | 87.3% | 44.40x † | 192 | 30 |
| 99223 Initial hospital care with moderate level of medical decision making, if using t | 183 | 80.9% | 8.68x | 174 | 34 |
| 99232 Subsequent hospital care with moderate levelof medical decision making, if using | 182 | 87.4% | 5.69x | 178 | 30 |
| 43775 Partial removal of stomach for weight loss using an endoscope | 158 | 90.5% | 40.12x † | 147 | 37 |
| 47563 Removal of gallbladder with X-ray study of bile ducts using an endoscope | 131 | 84.7% | 43.58x † | 94 | 32 |
| 99222 Initial hospital care with straightforward or low-level medical decision making, | 110 | 86.4% | 13.56x | 102 | 36.5 |
| 99284 Emergency department visit with moderate level of medical decision making | 99 | 79.8% | 7.10x | 89 | 53 |
| 99285 Emergency department visit with high level of medical decision making | 97 | 74.2% | 8.20x | 88 | 30 |
| 64999 Other procedure on nervous system | 81 | 87.7% | 31.39x † | 59 | 27 |
| 99291 Critical care, first 30-74 minutes | 81 | 80.2% | 6.59x | 79 | 36 |
| 99236 Initial hospital care with same-day admission and discharge with high level of m | 80 | 76.2% | 65.89x † | 71 | 32.5 |
| 99283 Emergency department visit with low level of medical decision making | 78 | 83.3% | 12.63x | 69 | 51 |
| 49594 Initial repair of entrapped hernia of abdomen, 3-10 cm in length | 72 | 87.5% | 21.24x † | 66 | 28 |
| 49591 Initial repair of sliding hernia of abdomen, less than 3 cm in length | 67 | 92.5% | 113.18x † | 59 | 30 |
| 99231 Subsequent hospital care with straightforward or low level of medical decision m | 62 | 72.6% | 104.40x † | 62 | 23.5 |
| 49592 Initial repair of entrapped hernia of abdomen, less than 3 cm in length | 60 | 88.3% | 26.92x † | 56 | 28 |
| 43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscop | 58 | 87.9% | 9.40x | 58 | 30 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in New York · General and other surgery in all states
FAQ
What is the Federal IDR provider win rate for general and other surgery in New York?
In 2025 Q1–Q4, the provider or facility offer was selected in 86.2% of 5,410 determined dispute line items for general and other 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 general and other surgery in New York?
In 2025 Q1–Q4, the median prevailing offer was 20.68x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 6.70x to 51.42x (n = 4,936 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 general and other surgery in New York?
In 2025 Q1–Q4, the median was 32 business days (n = 5,410 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).