Federal IDR outcomes: Plastic and reconstructive surgery in Virginia
In 2025 Q1–Q4, the provider or facility offer prevailed in 89.3% of 2,024 determined Federal IDR dispute line items for plastic and reconstructive surgery in Virginia. The median prevailing offer was 8.07x the QPA (25th–75th percentile 4.38x–16.09x; n = 1,977). The median time to a decision was 35 business days (n = 2,024).
Determined line items
2,024
2025 Q1–Q4 · 4 split decisions excluded
Provider win rate
89.3%
n = 2,024 · 2025 Q1–Q4
Median payment vs QPA
8.07x
middle half 4.38x–16.09x · n = 1,977 · 2025 Q1–Q4
Median days to decision
35
business days, from dispute initiation · n = 2,024 · 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 | 2,024 | 89.3% | 8.07x | 4.38x–16.09x | 1,977 | 35 |
| 2024 Q1–Q4 | 857 | 83.0% | 6.47x | 3.78x–12.82x | 779 | 132 |
| 2023 Q1–Q4 | 86 | 82.6% | 4.01x | 2.48x–7.41x | 86 | 55.5 |
| 2023 Q1–2025 Q4 | 2,967 | 87.3% | 7.46x | 4.08x–14.97x | 2,842 | 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 |
|---|---|---|---|---|---|
| 15002 Preparation of skin graft site of trunk, arms, or legs, 100.0 sq cm or 1% body a | 90 | 84.4% | 7.65x | 88 | 48.5 |
| 15734 Creation of muscle graft to trunk | 67 | 88.1% | 7.30x | 67 | 33 |
| 32900 Removal of ribs | 62 | 93.5% | 13.02x | 61 | 32 |
| 14301 Repair of wound by transferring skin, 30.1-60.0 sq cm | 59 | 89.8% | 7.87x | 59 | 34 |
| 15004 Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, aroun | 59 | 79.7% | 7.41x | 58 | 30 |
| 14302 Repair of wound by transferring skin, each additional 30.0 sq cm | 56 | 91.1% | 8.44x | 56 | 39 |
| 19380 Surgical change to reconstructed breast | 56 | 98.2% | 12.57x | 55 | 29 |
| 19357 Reconstruction of breast using tissue expander | 55 | 94.5% | 8.14x | 55 | 31 |
| 19364 Reconstruction of breast with tissue graft | 55 | 92.7% | 18.17x | 55 | 33 |
| 13160 Extensive or complicated repair of surface wound reopening | 51 | 80.4% | 6.55x | 49 | 37 |
| 15738 Creation of muscle graft to leg | 50 | 90.0% | 9.96x | 49 | 111.5 |
| 13101 Complicated repair of wound of trunk, 2.6-7.5 cm | 48 | 97.9% | 7.70x | 46 | 34 |
| 15771 Graft using patient's fat removed by liposuction and inserted into trunk, breast | 48 | 95.8% | 8.09x | 48 | 28.5 |
| 15772 Graft using patient's fat removed by liposuction and inserted into trunk, breast | 46 | 100.0% | 5.63x | 45 | 30 |
| 15777 Implantation of biologic implant to soft tissue | 45 | 93.3% | 13.92x | 44 | 28 |
| 13102 Complicated repair of wound of trunk, each additional 5.0 cm or less | 43 | 95.3% | 4.80x | 41 | 34 |
| 15003 Preparation of skin graft site of trunk, arms, or legs, each additional 100.0 sq | 38 | 89.5% | 10.02x | 38 | 39.5 |
| 19371 Removal of capsule around breast implant | 34 | 85.3% | 19.62x | 34 | 33 |
| 64708 Release of arm or leg nerve | 32 | 81.2% | 12.24x | 32 | 104 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Related: all specialties in Virginia · Plastic and reconstructive surgery in all states
FAQ
What is the Federal IDR provider win rate for plastic and reconstructive surgery in Virginia?
In 2025 Q1–Q4, the provider or facility offer was selected in 89.3% of 2,024 determined dispute line items for plastic and reconstructive surgery in Virginia. 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 Virginia?
In 2025 Q1–Q4, the median prevailing offer was 8.07x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 4.38x to 16.09x (n = 1,977 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 Virginia?
In 2025 Q1–Q4, the median was 35 business days (n = 2,024 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).