What General Surgery teams should benchmark
General 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 General Surgery service codes
| Code | Service | Disputes | Provider win rate | Median award | Median award dollars |
|---|---|---|---|---|---|
| 12001 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and | 7,851 | 80.1% | 6.2x | $644 |
| 12011 | Simple wound repair of the face or scalp, 2.5 cm or less | 4,779 | 80.5% | 5.9x | $758 |
| 19318 | Breast reduction | 4,738 | 84.7% | 46.8x | $75,000 |
| 12002 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and | 4,733 | 83% | 5.7x | $750 |
| 44970 | Laparoscopy, surgical, appendectomy | 4,269 | 84.9% | 24.0x | $18,000 |
| 47562 | Laparoscopy, surgical; cholecystectomy | 3,651 | 84.5% | 29.6x | $21,000 |
| 10061 | Incision and drainage of abscess, complicated or multiple | 3,281 | 79.5% | 4.5x | $1,229 |
| 19083 | Biopsy of breast and placement of locating device using ultrasound, first growth | 2,929 | 91.8% | 7.7x | $1,966 |
| 14301 | Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm | 2,621 | 86.1% | 22.7x | $19,000 |
| 13131 | Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or fee | 2,074 | 86.5% | 34.6x | $12,750 |
| 14302 | Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part t | 2,049 | 85.6% | 21.2x | $16,500 |
| 49083 | Drainage of fluid from abdominal cavity using imaging guidance | 2,030 | 90.6% | 7.6x | $1,141 |
| 47563 | Laparoscopy, surgical; cholecystectomy with cholangiography | 1,836 | 85.8% | 22.6x | $13,120 |
| 15734 | Muscle, myocutaneous, or fasciocutaneous flap; trunk | 1,771 | 85.3% | 20.4x | $32,000 |
| 19380 | Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or | 1,727 | 90.6% | 31.3x | $48,275 |
All General Surgery benchmark codes
| Code | Service | Disputes |
|---|---|---|
| 12001 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and | 7,851 |
| 12011 | Simple wound repair of the face or scalp, 2.5 cm or less | 4,779 |
| 19318 | Breast reduction | 4,738 |
| 12002 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and | 4,733 |
| 44970 | Laparoscopy, surgical, appendectomy | 4,269 |
| 47562 | Laparoscopy, surgical; cholecystectomy | 3,651 |
| 10061 | Incision and drainage of abscess, complicated or multiple | 3,281 |
| 19083 | Biopsy of breast and placement of locating device using ultrasound, first growth | 2,929 |
| 14301 | Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm | 2,621 |
| 13131 | Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or fee | 2,074 |
| 14302 | Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part t | 2,049 |
| 49083 | Drainage of fluid from abdominal cavity using imaging guidance | 2,030 |
| 47563 | Laparoscopy, surgical; cholecystectomy with cholangiography | 1,836 |
| 15734 | Muscle, myocutaneous, or fasciocutaneous flap; trunk | 1,771 |
| 19380 | Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or | 1,727 |
| 19357 | Tissue expander placement in breast reconstruction, including subsequent expansion(s) | 1,668 |
| 10060 | Simple or single drainage of skin abscess | 1,605 |
| 19081 | Biopsy of breast and placement of locating device using X-ray with needle, first growth | 1,580 |
| 12013 | Simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.6-5.0 cm | 1,554 |
| 15777 | Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforceme | 1,462 |
| 10005 | Fine needle aspiration biopsy using ultrasound guidance, first growth | 1,458 |
| 43775 | Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve | 1,312 |
| 13152 | Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm | 1,225 |
| 13132 | Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or fee | 1,215 |
| 43239 | Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple | 1,199 |
| 15002 | Surgical preparation or creation of recipient site by excision of open wounds, burn eschar | 1,150 |
| 13151 | Complicated repair of wound of eyelids, nose, ears, or lip, 1.1-2.5 cm | 1,117 |
| 15771 | Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, ar | 1,078 |
| 19364 | Reconstruction of breast with tissue graft | 1,038 |
| 49650 | Laparoscopy, surgical; repair initial inguinal hernia | 992 |
| 38222 | Biopsy and aspiration of bone marrow sample for diagnosis | 979 |
| 45499 | Other procedure on rectum using an endoscope | 924 |
| 19371 | Peri-implant capsulectomy, breast, complete, including removal of all intracapsular conten | 915 |
| 49406 | Drainage of fluid collection of abdominal cavity by tube using imaging guidance | 842 |
| 15772 | Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, ar | 839 |
| 47000 | Needle biopsy of liver through skin | 820 |
| 19342 | Insertion or replacement of breast implant on separate day from mastectomy | 793 |
| 12051 | Intermediate repair of wounds involving the face, ears, eyelids, nose, lips, or mucous mem | 700 |
| 38505 | Needle biopsy or removal of surface lymph nodes | 628 |
| 38530 | Biopsy or removal of lymph nodes of breast | 615 |
| 10120 | Removal of foreign body from tissue, accessed beneath the skin, simple | 589 |
| 13101 | Repair, complex, trunk; 2.6 cm to 7.5 cm | 581 |
| 44180 | Release of small bowel scar tissue using an endoscope | 563 |
| 13102 | Repair, complex, trunk; each additional 5 cm or less | 549 |
| 43281 | Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when perform | 548 |
| 10160 | Aspiration of abscess, blood, or cyst | 546 |
| 45380 | Biopsy of large bowel using a flexible endoscope | 536 |
| 19285 | Placement of locating device in breast using ultrasound guidance, first growth | 533 |
| 11042 | Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 s | 516 |
Top states for General Surgery disputes
| State | Disputes | Provider win rate | Median award |
|---|---|---|---|
| Texas | 26,953 | 85.9% | 7.3x |
| New Jersey | 25,238 | 86.3% | 27.7x |
| New York | 21,016 | 86.2% | 28.8x |
| California | 7,819 | 88% | 43.9x |
| Florida | 6,911 | 90.6% | 6.2x |
| Arizona | 6,077 | 84.1% | 8.0x |
| Connecticut | 3,355 | 89.7% | 34.2x |
| Indiana | 1,326 | 84.2% | 7.4x |
| Tennessee | 1,324 | 82.1% | 2.9x |
| Colorado | 1,324 | 81.4% | 4.9x |
Top payers in General Surgery
| Payer | Disputes | Provider win rate | Median award |
|---|---|---|---|
| UnitedHealthcare | 24,942 | 83.6% | 13.5x |
| Aetna | 23,601 | 92.2% | 10.1x |
| Cigna / MultiPlan | 17,366 | 83.9% | 17.1x |
| Anthem Blue Cross | 12,234 | 89.6% | 29.2x |
| BCBSTX | 9,129 | 84.3% | 6.6x |
| UMR (clearhs.com) | 4,597 | 83.9% | 10.1x |
| Cigna | 4,163 | 83.6% | 8.8x |
| BCBSAZ | 2,227 | 81.1% | 9.7x |
| Horizon | 1,537 | 86.8% | 28.1x |
| Emblem Health | 1,473 | 89.2% | 19.0x |
Filing checklist before you take General Surgery claims to IDR
- Confirm the claim is NSA-eligible: emergency care, or out-of-network care at an in-network facility, with no state arbitration law that displaces the federal process for that plan type.
- Start open negotiation within 30 business days of the initial payment or denial notice. The negotiation window then runs 30 business days.
- If negotiation fails, initiate federal IDR through the portal within 4 business days after the window closes.
- Batch same-payer items in the same service code category. Open negotiation periods starting on or after November 1, 2026 can batch up to 50 line items per dispute, up from 25.
- Budget for fees: the federal administrative fee is $15 per party for disputes initiated on or after June 11, 2026 (down from $115), and the non-prevailing party pays the certified IDR entity fee.
- Anchor your offer to the data: the General Surgery median provider-won award is 12.9x QPA across 113,062 disputes.
The fee and batching changes come from the May 2026 federal IDR operations final rule. See the 2026 and 2027 No Surprises Act changes guide for the full timeline, or request a free NSA audit to see how your claims compare.
Open the General Surgery dashboard
Filter General Surgery disputes by state, payer, and year to compare the public benchmark with your own out-of-network payment experience.
FAQ
How many General Surgery federal IDR disputes are in the dataset?
This benchmark shows 113,062 General Surgery disputes.
What is the General Surgery provider win rate?
The non-default provider win rate is 86.2%.
What should General 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.
What changes in 2026 and 2027 affect General Surgery IDR filings?
The administrative fee dropped to $15 per party for disputes initiated on or after June 11, 2026, batching expands to 50 line items for open negotiation periods starting on or after November 1, 2026, and standardized CARC/RARC remittance codes arrive January 1, 2027.
Related benchmarks
Sources and method
Providers won 85.8% of 3.39 million federal IDR disputes through 2025Q4, with a median provider-won award of 4.7x the qualifying payment amount, per CMS public use files.
- CMS: Federal IDR reports and public use files
- CMS: Federal IDR operations final rule fact sheet
- CMS: Federal IDR timeline for claims
Data source: CMS Federal IDR public use files, coverage through 2025Q4; data build 2026-09-24. Counts are CMS dispute counts unless a table says line items. Win rates on this page exclude payer no-show defaults unless labeled otherwise. Award multiples are medians versus the qualifying payment amount (QPA). Dollar figures, where shown, come from CMS QPA-and-offer fields or are anchored estimates, not payment records. This page is informational, not legal or reimbursement advice.