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 integral an | 6,845 | 85.4% | 99.6x | $22,050 |
| 29584 | Multi-layer compression bandage, arm/forearm/hand | 5,601 | 68.4% | 8.1x | $603 |
| 22551 | Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytec | 3,705 | 84.9% | 30.9x | $22,002 |
| 22845 | Anterior instrumentation; 2 to 3 vertebral segments | 2,930 | 84.2% | 42.4x | $18,814 |
| 29826 | Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromiopl | 2,761 | 85.6% | 51.2x | $5,000 |
| 27447 | Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without p | 2,754 | 87.5% | 17.0x | $6,764 |
| 29827 | Arthroscopy, shoulder, surgical; with rotator cuff repair | 2,636 | 86.7% | 20.7x | $5,662 |
| 29125 | Application of nonmoveable forearm to hand splint | 2,553 | 78.7% | 4.9x | $432 |
| 22612 | Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with latera | 2,501 | 83.2% | 30.6x | $15,781 |
| 22842 | Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks a | 2,340 | 84.1% | 40.4x | $19,950 |
| 22552 | Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytec | 2,318 | 85% | 50.0x | $10,790 |
| 22614 | Arthrodesis, posterior or posterolateral technique, single interspace; each additional int | 2,316 | 83.3% | 51.4x | $20,288 |
| 22840 | Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation ac | 2,252 | 85.4% | 42.5x | $18,000 |
| 22558 | Arthrodesis, anterior interbody technique, including minimal discectomy to prepare intersp | 2,232 | 85.7% | 45.9x | $55,876 |
| 20610 | Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee | 2,161 | 85% | 21.7x | $4,500 |
All Orthopedic Surgery benchmark codes
| Code | Service | Disputes |
|---|---|---|
| 22853 | Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral an | 6,845 |
| 29584 | Multi-layer compression bandage, arm/forearm/hand | 5,601 |
| 22551 | Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytec | 3,705 |
| 22845 | Anterior instrumentation; 2 to 3 vertebral segments | 2,930 |
| 29826 | Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromiopl | 2,761 |
| 27447 | Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without p | 2,754 |
| 29827 | Arthroscopy, shoulder, surgical; with rotator cuff repair | 2,636 |
| 29125 | Application of nonmoveable forearm to hand splint | 2,553 |
| 22612 | Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with latera | 2,501 |
| 22842 | Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks a | 2,340 |
| 22552 | Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytec | 2,318 |
| 22614 | Arthrodesis, posterior or posterolateral technique, single interspace; each additional int | 2,316 |
| 22840 | Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation ac | 2,252 |
| 22558 | Arthrodesis, anterior interbody technique, including minimal discectomy to prepare intersp | 2,232 |
| 20610 | Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee | 2,161 |
| 27130 | Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplas | 1,979 |
| 22633 | Arthrodesis, combined posterior or posterolateral technique with posterior interbody techn | 1,756 |
| 29823 | Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (eg | 1,709 |
| 29888 | Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction | 1,606 |
| 29881 | Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal | 1,564 |
| 29515 | Application of short leg splint (calf to foot) | 1,409 |
| 29828 | Arthroscopy, shoulder, surgical; biceps tenodesis | 1,246 |
| 29824 | Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface | 1,238 |
| 25605 | Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separa | 1,155 |
| 23650 | Closed treatment of dislocated shoulder with manipulation | 1,070 |
| 22585 | Arthrodesis, anterior interbody technique, including minimal discectomy to prepare intersp | 1,011 |
| 22856 | Total disc arthroplasty (artificial disc), anterior approach, including discectomy with en | 988 |
| 20930 | Allograft, morselized, or placement of osteopromotive material, for spine surgery only | 965 |
| 20936 | Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous | 925 |
| 29130 | Application of nonmoveable finger splint | 795 |
| 29505 | Application of long leg splint (thigh to ankle or toes) | 778 |
| 23430 | Tenodesis of long tendon of biceps | 769 |
| 29914 | Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion) | 758 |
| 22846 | Anterior instrumentation; 4 to 7 vertebral segments | 757 |
| 29105 | Application of lower and upper arm splint | 729 |
| 29916 | Arthroscopy, hip, surgical; with labral repair | 728 |
| 29882 | Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) | 711 |
| 29880 | Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal | 709 |
| 22600 | Arthrodesis, posterior or posterolateral technique, single interspace; cervical below C2 s | 701 |
| 20680 | Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) | 689 |
| 23350 | Injection of contrast for imaging of shoulder joint | 647 |
| 27096 | Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoros | 621 |
| 29879 | Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary | 621 |
| 29806 | Arthroscopy, shoulder, surgical; capsulorrhaphy | 618 |
| 25600 | Closed treatment of broken forearm (radius) bone at the wrist area on the thumb side of th | 594 |
| 29876 | Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (eg, medial or lat | 556 |
Top states for Orthopedic Surgery disputes
| State | Disputes | Provider win rate | Median award |
|---|---|---|---|
| Texas | 32,019 | 83.9% | 20.2x |
| New Jersey | 31,146 | 85.6% | 33.5x |
| New York | 13,730 | 85.8% | 34.3x |
| California | 5,136 | 83% | 57.5x |
| Arizona | 2,875 | 82.1% | 9.6x |
| Florida | 1,960 | 86.4% | 11.0x |
| Georgia | 1,330 | 78.5% | 1.0x |
| Wisconsin | 1,041 | 88.1% | 23.1x |
| Tennessee | 634 | 78.5% | 2.9x |
| Virginia | 356 | 84.6% | 5.7x |
Top payers in Orthopedic Surgery
| Payer | Disputes | Provider win rate | Median award |
|---|---|---|---|
| BCBSTX | 17,756 | 86.8% | 23.9x |
| Cigna / MultiPlan | 17,011 | 81.9% | 28.4x |
| UnitedHealthcare | 16,483 | 82.1% | 28.7x |
| Aetna | 14,796 | 89.6% | 21.8x |
| Anthem Blue Cross | 7,593 | 88.5% | 37.8x |
| UMR (clearhs.com) | 4,382 | 82.2% | 20.4x |
| Emblem Health | 2,777 | 87.7% | 29.5x |
| Cigna | 2,257 | 80.9% | 10.8x |
| Horizon | 1,779 | 83.1% | 33.4x |
| BCBSAZ | 1,470 | 81.3% | 9.7x |
Filing checklist before you take Orthopedic 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 Orthopedic Surgery median provider-won award is 25.6x QPA across 94,716 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 Orthopedic Surgery dashboard
Filter Orthopedic Surgery disputes by state, payer, and year to compare the public benchmark with your own out-of-network payment experience.
FAQ
How many Orthopedic Surgery federal IDR disputes are in the dataset?
This benchmark shows 94,716 Orthopedic Surgery disputes.
What is the Orthopedic Surgery provider win rate?
The non-default provider win rate is 84.6%.
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.
What changes in 2026 and 2027 affect Orthopedic 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.