Federal IDR outcomes: Plastic and reconstructive surgery in New York
In 2025 Q1–Q4, the provider or facility offer prevailed in 87.5% of 13,107 determined Federal IDR dispute line items for plastic and reconstructive surgery in New York. The median prevailing offer was 24.74x the QPA (25th–75th percentile 9.10x–59.81x; n = 12,247). The median time to a decision was 31 business days (n = 13,107).
Determined line items
13,107
2025 Q1–Q4 · 20 split decisions excluded
Provider win rate
87.5%
n = 13,107 · 2025 Q1–Q4
Median days to decision
31
business days, from dispute initiation · n = 13,107 · 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 | 13,107 | 87.5% | 24.74x † | 9.10x–59.81x | 12,247 | 31 |
| 2024 Q1–Q4 | 4,661 | 90.0% | 17.30x | 7.05x–37.57x | 4,320 | 55 |
| 2023 Q1–Q4 | 523 | 85.3% | 12.80x | 4.62x–24.87x | 502 | 82 |
| 2023 Q1–2025 Q4 | 18,291 | 88.1% | 21.57x † | 8.20x–52.43x | 17,069 | 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 | 1,536 | 84.5% | 44.38x † | 1,483 | 32 |
| 14301 Repair of wound by transferring skin, 30.1-60.0 sq cm | 646 | 86.7% | 19.43x | 623 | 32 |
| 14302 Repair of wound by transferring skin, each additional 30.0 sq cm | 530 | 87.0% | 21.15x † | 495 | 32 |
| 15734 Creation of muscle graft to trunk | 436 | 87.6% | 16.68x | 413 | 35 |
| 13131 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, g | 377 | 86.5% | 27.25x † | 365 | 29 |
| 15002 Preparation of skin graft site of trunk, arms, or legs, 100.0 sq cm or 1% body a | 348 | 89.4% | 33.17x † | 337 | 34 |
| 13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm | 340 | 84.1% | 27.26x † | 316 | 31 |
| 99283 Emergency department visit with low level of medical decision making | 334 | 88.9% | 34.22x † | 312 | 32.5 |
| 19380 Surgical change to reconstructed breast | 271 | 90.0% | 21.02x † | 248 | 31 |
| 13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, g | 264 | 91.7% | 23.90x † | 234 | 33 |
| 15777 Implantation of biologic implant to soft tissue | 259 | 89.2% | 44.05x † | 241 | 34 |
| 15771 Graft using patient's fat removed by liposuction and inserted into trunk, breast | 229 | 90.0% | 30.85x † | 216 | 29 |
| 15830 Removal of extra skin and tissue of abdomen | 221 | 82.8% | 23.07x † | 213 | 30 |
| 13102 Complicated repair of wound of trunk, each additional 5.0 cm or less | 218 | 89.0% | 58.71x † | 211 | 30 |
| 13151 Complicated repair of wound of eyelids, nose, ears, or lip, 1.1-2.5 cm | 207 | 85.5% | 23.52x † | 199 | 30 |
| 19371 Removal of capsule around breast implant | 195 | 83.6% | 48.24x † | 184 | 30 |
| 13101 Complicated repair of wound of trunk, 2.6-7.5 cm | 182 | 89.0% | 13.45x | 171 | 30 |
| 15004 Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, aroun | 168 | 91.7% | 14.22x | 166 | 30 |
| 15772 Graft using patient's fat removed by liposuction and inserted into trunk, breast | 168 | 88.1% | 49.73x † | 159 | 31.5 |
| 11042 Removal of skin and tissue, 20.0 sq cm or less | 164 | 90.9% | 65.04x † | 135 | 34 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in New York · Plastic and reconstructive surgery in all states
FAQ
What is the Federal IDR provider win rate for plastic and reconstructive surgery in New York?
In 2025 Q1–Q4, the provider or facility offer was selected in 87.5% of 13,107 determined dispute line items for plastic and reconstructive 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 plastic and reconstructive surgery in New York?
In 2025 Q1–Q4, the median prevailing offer was 24.74x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 9.10x to 59.81x (n = 12,247 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 York?
In 2025 Q1–Q4, the median was 31 business days (n = 13,107 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).