Federal IDR outcomes: Plastic and reconstructive surgery in Texas
In 2025 Q1–Q4, the provider or facility offer prevailed in 94.9% of 1,305 determined Federal IDR dispute line items for plastic and reconstructive surgery in Texas. The median prevailing offer was 12.79x the QPA (25th–75th percentile 7.85x–20.86x; n = 1,259). The median time to a decision was 48 business days (n = 1,305).
Determined line items
1,305
2025 Q1–Q4 · 2 split decisions excluded
Provider win rate
94.9%
n = 1,305 · 2025 Q1–Q4
Median payment vs QPA
12.79x
middle half 7.85x–20.86x · n = 1,259 · 2025 Q1–Q4
Median days to decision
48
business days, from dispute initiation · n = 1,305 · 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 | 1,305 | 94.9% | 12.79x | 7.85x–20.86x | 1,259 | 48 |
| 2024 Q1–Q4 | 701 | 88.0% | 10.78x | 5.72x–19.85x | 649 | 75 |
| 2023 Q1–Q4 | 106 | 89.6% | 12.68x | 9.49x–17.58x | 106 | 62 |
| 2023 Q1–2025 Q4 | 2,112 | 92.3% | 12.22x | 7.28x–20.59x | 2,014 | 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 |
|---|---|---|---|---|---|
| 11046 Removal of muscle and/or tissue, each additional 20.0 sq cm or less | 182 | 100.0% | 14.04x | 166 | 56 |
| 14302 Repair of wound by transferring skin, each additional 30.0 sq cm | 155 | 96.8% | 7.85x | 154 | 58 |
| 14301 Repair of wound by transferring skin, 30.1-60.0 sq cm | 69 | 88.4% | 11.20x | 68 | 36 |
| 19357 Reconstruction of breast using tissue expander | 36 | 97.2% | 202.36x † | 35 | 34.5 |
| 11047 Removal of bone, each additional 20.0 sq cm or less | 35 | 100.0% | 20.86x † | 35 | 394 |
| 15002 Preparation of skin graft site of trunk, arms, or legs, 100.0 sq cm or 1% body a | 32 | 100.0% | 10.60x | 31 | 60.5 |
| 15003 Preparation of skin graft site of trunk, arms, or legs, each additional 100.0 sq | 30 | 100.0% | – | 29 | 53 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in Texas · Plastic and reconstructive surgery in all states
FAQ
What is the Federal IDR provider win rate for plastic and reconstructive surgery in Texas?
In 2025 Q1–Q4, the provider or facility offer was selected in 94.9% of 1,305 determined dispute line items for plastic and reconstructive 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 plastic and reconstructive surgery in Texas?
In 2025 Q1–Q4, the median prevailing offer was 12.79x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 7.85x to 20.86x (n = 1,259 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 Texas?
In 2025 Q1–Q4, the median was 48 business days (n = 1,305 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).