Federal IDR outcomes: Orthopedic surgery in Texas
In 2025 Q1–Q4, the provider or facility offer prevailed in 88.0% of 1,577 determined Federal IDR dispute line items for orthopedic surgery in Texas. The median prevailing offer was 29.84x the QPA (25th–75th percentile 10.13x–50.79x; n = 1,489). The median time to a decision was 32 business days (n = 1,577).
Determined line items
1,577
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
88.0%
n = 1,577 · 2025 Q1–Q4
Median days to decision
32
business days, from dispute initiation · n = 1,577 · 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 | 1,577 | 88.0% | 29.84x † | 10.13x–50.79x | 1,489 | 32 |
| 2024 Q1–Q4 | 110 | 80.0% | 6.93x | 1.36x–21.97x | 106 | 40 |
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 1,689 | 87.4% | 27.77x † | 8.68x–50.09x | 1,597 | 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 |
|---|---|---|---|---|---|
| 27447 Replacement of knee joint, both sides of knee | 170 | 85.9% | 8.72x | 169 | 32 |
| 27130 Replacement of thigh bone and hip joint with prosthesis | 132 | 90.2% | 43.99x † | 127 | 34.5 |
| 29827 Repair of shoulder rotator cuff using an endoscope | 55 | 89.1% | 20.68x † | 55 | 31 |
| 29881 Removal of knee cartilage using an endoscope | 53 | 88.7% | 39.53x † | 53 | 33 |
| 29888 Repair of anterior cruciate ligament of knee using an endoscope | 53 | 90.6% | 31.78x † | 53 | 32 |
| 63030 Partial removal of spine bone with release of lower spinal cord or nerves and/or | 53 | 90.6% | 35.24x † | 53 | 42 |
| 63047 Partial removal of spine bone with release of lower spinal cord and/or nerves, 1 | 44 | 72.7% | 53.88x † | 43 | 31 |
| 95870 Needle measurement of electrical activity in arm, leg, trunk or head muscles, li | 40 | 95.0% | – | 20 | 34 |
| 22612 Fusion of spine in lower back | 30 | 83.3% | – | 28 | 31.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in Texas · Orthopedic surgery in all states
FAQ
What is the Federal IDR provider win rate for orthopedic surgery in Texas?
In 2025 Q1–Q4, the provider or facility offer was selected in 88.0% of 1,577 determined dispute line items for orthopedic 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 orthopedic surgery in Texas?
In 2025 Q1–Q4, the median prevailing offer was 29.84x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 10.13x to 50.79x (n = 1,489 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 Texas?
In 2025 Q1–Q4, the median was 32 business days (n = 1,577 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).