What Orthopedic Surgery teams should benchmark
Orthopedic Surgery IDR outcomes are shaped by code mix. The same payer can look fair in one lane and misaligned in another. Start with the codes that dominate your disputed claims, then compare state and payer behavior.
The purpose of this page is to help a specialty leader or RCM team decide where the federal IDR data supports a closer claim-level review.
Top Orthopedic Surgery service codes
| Code | Service | Disputes | Provider win rate | Median award | Median award dollars |
|---|---|---|---|---|---|
| 22853 | Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with... | 4,714 | 84.8% | 102x | $24K |
| 29584 | Multi-layer compression bandage, arm/forearm/hand | 3,512 | 73.5% | 10.2x | $603 |
| 22551 | Arthrodesis, anterior interbody, including disc space preparation, discectomy,... | 2,491 | 84.7% | 31.9x | $19K |
| 29125 | Application of short arm splint (forearm to hand), static | 2,108 | 79.9% | 4.8x | $347 |
| 22845 | Anterior instrumentation; 2 to 3 vertebral segments | 2,001 | 84.4% | 45.9x | $20K |
| 29826 | Arthroscopy, shoulder, surgical; decompression of subacromial space with partial... | 1,947 | 84% | 50.1x | $6,000 |
| 29827 | Arthroscopy, shoulder, surgical; with rotator cuff repair | 1,851 | 85.5% | 21.0x | $5,662 |
| 27447 | Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or... | 1,849 | 86.5% | 11.9x | $7,324 |
Top states for Orthopedic Surgery disputes
| State | Disputes | Provider win rate | Median award |
|---|---|---|---|
| Texas | 20,864 | 83.7% | 24.1x |
| New Jersey | 20,336 | 86.2% | 38.5x |
| New York | 9,521 | 86.2% | 37.9x |
| California | 4,284 | 83.1% | 62.1x |
| Arizona | 1,946 | 84.3% | 17.0x |
| Florida | 1,307 | 86.7% | 22.1x |
| Georgia | 695 | 78.7% | 1.0x |
| Wisconsin | 513 | 89.2% | 23.4x |
Top payers in Orthopedic Surgery
| Payer | Disputes | Provider win rate | Median award |
|---|---|---|---|
| BCBSTX | 11,824 | 86.9% | 25.9x |
| Cigna / MultiPlan | 11,133 | 81.8% | 31.3x |
| UnitedHealthcare | 10,902 | 81.6% | 31.1x |
| Aetna | 8,946 | 91.5% | 29.0x |
| Anthem Blue Cross | 5,493 | 88.6% | 46.7x |
| UMR | 3,242 | 82.8% | 23.0x |
| EMBLEM HEALTH | 2,374 | 88.3% | 30.2x |
| Cigna (cigna.com) | 1,407 | 81.7% | 16.3x |
Open the Orthopedic Surgery dashboard
Filter the live explorer by state, payer, and year to compare Orthopedic Surgery outcomes against your own claim mix.
FAQ
How many Orthopedic Surgery federal IDR disputes are in the dataset?
This benchmark shows 63,605 Orthopedic Surgery disputes.
What is the Orthopedic Surgery provider win rate?
The non-default provider win rate is 85%.
What should Orthopedic Surgery groups compare first?
Start with service-code mix, then narrow by payer and state. That sequence usually gives a more useful answer than a national specialty average.
Related benchmarks
Sources and method
- CMS: Federal IDR reports and public use files
- CMS: About Independent Dispute Resolution
- CMS: Federal IDR timeline for claims
Data source: CMS Federal IDR public use files, coverage through 2025Q4; data build 2026-09-21. Counts are CMS dispute counts unless a table says line items. Win rates labeled non-default exclude payer no-show defaults. Award multiples are medians versus QPA. Dollar figures, where shown, are anchored estimates from CMS QPA-and-offer fields, not payment records. This page is informational, not legal or reimbursement advice.