Federal IDR outcomes: Orthopedic surgery in New York
In 2025 Q1–Q4, the provider or facility offer prevailed in 88.3% of 6,256 determined Federal IDR dispute line items for orthopedic surgery in New York. The median prevailing offer was 34.39x the QPA (25th–75th percentile 12.26x–77.11x; n = 4,972). The median time to a decision was 34 business days (n = 6,256).
Determined line items
6,256
2025 Q1–Q4 · 22 split decisions excluded
Provider win rate
88.3%
n = 6,256 · 2025 Q1–Q4
Median days to decision
34
business days, from dispute initiation · n = 6,256 · 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 | 6,256 | 88.3% | 34.39x † | 12.26x–77.11x | 4,972 | 34 |
| 2024 Q1–Q4 | 1,737 | 84.0% | 20.72x † | 5.48x–58.07x | 1,396 | 53 |
| 2023 Q1–Q4 | 112 | 82.1% | 8.80x | 4.02x–17.26x | 106 | 72.5 |
| 2023 Q1–2025 Q4 | 8,105 | 87.3% | 30.70x † | 9.94x–72.00x | 6,474 | 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 |
|---|---|---|---|---|---|
| 22853 Insertion of cage or mesh device to spine bone and disc space during spine fusio | 224 | 84.4% | 81.99x † | 175 | 34 |
| 22614 Fusion of additional segment of spine | 161 | 87.0% | 58.82x † | 118 | 42 |
| 63047 Partial removal of spine bone with release of lower spinal cord and/or nerves, 1 | 149 | 85.2% | 46.17x † | 119 | 31 |
| 76000 Imaging guidance for procedure, 60 minutes or less | 138 | 84.8% | 30.70x † | 102 | 39 |
| 22612 Fusion of spine in lower back | 127 | 85.0% | 38.96x † | 112 | 37 |
| 22845 Placement of stabilizing device to front, 2-3 spine bone segments | 124 | 87.1% | 40.44x † | 99 | 34 |
| 63048 Partial removal of spine bone with release of spinal cord and/or nerves, each ad | 121 | 90.1% | 77.03x † | 82 | 45 |
| 29826 Shaving of part of shoulder bone and repair of ligament using an endoscope | 117 | 90.6% | 68.09x † | 85 | 29 |
| 63030 Partial removal of spine bone with release of lower spinal cord or nerves and/or | 107 | 83.2% | 63.80x † | 99 | 36 |
| 22551 Fusion of upper spine bone with removal of disc and release of spinal cord or ne | 100 | 84.0% | 30.66x † | 80 | 31.5 |
| 29876 Removal of joint lining from multiple knee joint compartments using an endoscope | 99 | 97.0% | 14.51x | 38 | 39 |
| 29881 Removal of knee cartilage using an endoscope | 96 | 92.7% | 25.58x † | 68 | 30 |
| 29823 Removal of extensive shoulder joint tissue using an endoscope | 93 | 93.5% | 69.47x † | 56 | 27 |
| 22842 Placement of stabilizing device to back, 3-6 spine bone segments | 92 | 85.9% | 33.64x † | 68 | 32 |
| 64722 Release of unspecified nerve | 90 | 94.4% | 91.04x † | 54 | 28 |
| 29827 Repair of shoulder rotator cuff using an endoscope | 86 | 91.9% | 25.90x † | 76 | 25.5 |
| 22840 Placement of stabilizing device to back of 1 spine bone in neck | 82 | 87.8% | 35.40x † | 72 | 35.5 |
| 27447 Replacement of knee joint, both sides of knee | 77 | 84.4% | 22.56x † | 72 | 30 |
| 20937 Harvest of bone fragment for spine bone graft | 75 | 88.0% | 25.03x † | 63 | 39 |
| 61783 Computer-assisted spinal procedure | 74 | 90.5% | 51.58x † | 56 | 41 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in New York · Orthopedic surgery in all states
FAQ
What is the Federal IDR provider win rate for orthopedic surgery in New York?
In 2025 Q1–Q4, the provider or facility offer was selected in 88.3% of 6,256 determined dispute line items for orthopedic 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 orthopedic surgery in New York?
In 2025 Q1–Q4, the median prevailing offer was 34.39x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 12.26x to 77.11x (n = 4,972 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 orthopedic surgery in New York?
In 2025 Q1–Q4, the median was 34 business days (n = 6,256 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).