Federal IDR outcomes: General and other surgery in Texas
In 2025 Q1–Q4, the provider or facility offer prevailed in 78.6% of 4,064 determined Federal IDR dispute line items for general and other surgery in Texas. The median prevailing offer was 9.35x the QPA (25th–75th percentile 3.30x–24.25x; n = 2,545). The median time to a decision was 31 business days (n = 4,064).
Determined line items
4,064
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
78.6%
n = 4,064 · 2025 Q1–Q4
Median payment vs QPA
9.35x
middle half 3.30x–24.25x · n = 2,545 · 2025 Q1–Q4
Median days to decision
31
business days, from dispute initiation · n = 4,064 · 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 | 4,064 | 78.6% | 9.35x | 3.30x–24.25x | 2,545 | 31 |
| 2024 Q1–Q4 | 671 | 89.0% | 4.48x | 1.10x–10.98x | 375 | 41 |
| 2023 Q1–Q4 | 123 | 35.8% | 0.80x | 0.17x–1.00x | 118 | 99 |
| 2023 Q1–2025 Q4 | 4,858 | 79.0% | 7.30x | 2.43x–20.74x | 3,038 | 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 |
|---|---|---|---|---|---|
| 99285 Emergency department visit with high level of medical decision making | 123 | 87.8% | 6.20x | 60 | 33 |
| 22558 Fusion of lower spine bone through abdomen with partial removal of disc | 111 | 90.1% | 16.63x | 40 | 28 |
| 44970 Removal of appendix using an endoscope | 103 | 85.4% | 19.31x | 46 | 29 |
| 85025 Complete blood cell count (red cells, white blood cell, platelets), automated te | 91 | 75.8% | 9.87x | 54 | 31 |
| 80051 Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide) | 83 | 75.9% | 9.87x | 51 | 31 |
| 82550 Creatine kinase (cardiac enzyme) level, total | 83 | 75.9% | 9.87x | 51 | 31 |
| 82565 Blood creatinine level | 83 | 75.9% | 9.87x | 51 | 31 |
| 84520 Urea nitrogen level to assess kidney function, quantitative | 83 | 75.9% | 9.87x | 51 | 31 |
| 82947 Blood glucose (sugar) level | 82 | 76.8% | 9.87x | 50 | 31.5 |
| 99291 Critical care, first 30-74 minutes | 76 | 93.4% | 3.36x | 59 | 32 |
| 96361 Infusion into a vein for hydration, each additional hour | 68 | 77.9% | 9.87x | 40 | 32.5 |
| 47562 Removal of gallbladder using an endoscope | 65 | 87.7% | – | 28 | 29 |
| 84155 Total protein level, blood | 60 | 71.7% | 7.30x | 35 | 32.5 |
| 22585 Fusion of spine bones through front of body with partial removal of disc, each a | 59 | 89.8% | – | 19 | 30 |
| 82040 Albumin (protein) level | 58 | 70.7% | 7.29x | 35 | 33 |
| 82150 Amylase (enzyme) level | 58 | 70.7% | 7.29x | 35 | 33 |
| 82247 Bilirubin level, total | 58 | 70.7% | 7.29x | 35 | 33 |
| 82977 Glutamyltransferase (liver enzyme) level | 58 | 70.7% | 7.29x | 35 | 33 |
| 84075 Phosphatase (enzyme) level, alkaline | 58 | 70.7% | 7.29x | 35 | 33 |
| 84450 Liver enzyme (SGOT), level | 58 | 70.7% | 7.29x | 35 | 33 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in Texas · General and other surgery in all states
FAQ
What is the Federal IDR provider win rate for general and other surgery in Texas?
In 2025 Q1–Q4, the provider or facility offer was selected in 78.6% of 4,064 determined dispute line items for general and other surgery in Texas. 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 Texas?
In 2025 Q1–Q4, the median prevailing offer was 9.35x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 3.30x to 24.25x (n = 2,545 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 Texas?
In 2025 Q1–Q4, the median was 31 business days (n = 4,064 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).