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The orthopedic IDR record
CMS published 63,605 federal IDR disputes with orthopedic surgery line items for 2025. Surgeons won 85 percent of decided disputes, the median award was 29.7 times the qualifying payment amount across decided line items, and the median decision took 31 days. The quarterly median multiple roughly doubled between late 2024 and late 2025.
Volume and trajectory
Orthopedic surgery generated 63,605 published No Surprises Act disputes in 2025, more than double its pace from a year earlier: quarterly volume grew from about 8,100 disputes in the third quarter of 2024 to above 17,000 by the second half of 2025. The award trend is steeper than the volume trend. The median decided multiple was around 20x in late 2024 and roughly 32x by the end of 2025, meaning arbitrators accepted progressively stronger offers as the published record accumulated.
Spine hardware dominates the dollars
The biggest orthopedic code by volume was the interbody biomechanical device line, 22853, with 4,714 disputes, a median QPA of $113, and a median decided award of $24,000. Anterior spine instrumentation (22845) paid a median of $20,000 against a $181 QPA, and anterior cervical fusion (22551) paid $18,700 against $406. Outside the spine, shoulder arthroscopy with decompression (29826) paid a median of $6,000 at roughly 50 times its QPA. The pattern across the top codes: device and instrumentation lines carry tiny payer benchmarks that arbitrators consistently decline to adopt.
Not every line is a spine line
The record also includes the specialty's small-dollar work. Application of a prefabricated splint (29584) and forearm splint lines (29125) won less often, 73 to 80 percent of decided disputes, and paid medians of $347 to $603. The lesson is in the contrast: orthopedic filing strategy is really two strategies, standalone disputes for the instrumented cases where a single line justifies its own arbitration, and batching for the fracture clinic volume.
The payers and the stakes
The 2025 counterparties were evenly spread: Blue Cross Blue Shield of Texas at 11,824 disputes, Cigna at 11,133, United Healthcare at 10,902, and Aetna at 8,946, with win rates holding near 85 percent against each. For a surgical group, the practical takeaway is dollar-weighted: at these award sizes a handful of decided spine disputes can move annual collections, and the published record at idrexplorer.com shows exactly what comparable lines paid. Lido IDR prices offers from that record and files for a flat fee per arbitration.
Price your cases against the record
Lido IDR anchors orthopedic offers to published awards for your codes and payers, then files for a flat fee per arbitration. Talk to an IDR specialist.