Federal IDR outcomes: Orthopedic surgery in Pennsylvania
In 2025 Q1–Q4, the provider or facility offer prevailed in 87.9% of 141 determined Federal IDR dispute line items for orthopedic surgery in Pennsylvania. The median prevailing offer was 405.11x the QPA (25th–75th percentile 261.24x–793.80x; n = 136). The median time to a decision was 17 business days (n = 141).
Determined line items
141
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
87.9%
n = 141 · 2025 Q1–Q4
Median days to decision
17
business days, from dispute initiation · n = 141 · 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 | 141 | 87.9% | 405.11x † | 261.24x–793.80x | 136 | 17 |
| 2024 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 145 | 88.3% | 405.11x † | 261.24x–793.80x | 136 | 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
No row has 30 or more determined line items in 2025 Q1–Q4.
Related: all specialties in Pennsylvania · Orthopedic surgery in all states
FAQ
What is the Federal IDR provider win rate for orthopedic surgery in Pennsylvania?
In 2025 Q1–Q4, the provider or facility offer was selected in 87.9% of 141 determined dispute line items for orthopedic surgery in Pennsylvania. 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 Withdrawn, settled and ineligible disputes are not in the CMS data.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 Pennsylvania?
In 2025 Q1–Q4, the median prevailing offer was 405.11x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 261.24x to 793.80x (n = 136 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 Pennsylvania?
In 2025 Q1–Q4, the median was 17 business days (n = 141 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).