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What surgery center codes pay in federal IDR
Among the surgery center codes in 2025 No Surprises Act arbitration, anesthesia for a screening colonoscopy (00812) was the most disputed, with 20,409 disputes, an 81.49 percent provider win rate, a median QPA of $245.43, and a median decided award of $1,755.00. Orthopedic and eye anesthesia codes decided between $1,552.50 and $5,222.80, while nerve block and spinal injection codes decided at $2,062.50 to $14,000.00 against QPAs of $86.81 to $236.25. Each figure is a median over lines that report a QPA and offers.
Endoscopy anesthesia sets the baseline
Four endoscopy anesthesia codes make up the largest block of surgery center volume. Screening colonoscopy anesthesia (00812) appeared in 20,409 disputes and providers won 81.49 percent, with a median QPA of $245.43 and a median decided award of $1,755.00. Upper endoscopy anesthesia (00731) appeared in 7,041 disputes (79.59 percent won; $270.82 and $1,988.00), lower endoscopy anesthesia (00811) in 6,646 (76.41 percent; $272.29 and $1,989.00), and the combined upper and lower code (00813) in 6,528 (79.81 percent; $314.21 and $2,320.50). Those medians come from lines at surgery centers that report a QPA and offers, 32,471, 9,699, 7,940, and 9,591 of them in turn.
Orthopedic, eye, and ENT anesthesia
The other common anesthesia codes decided at medians from $1,552.50 to $5,222.80. Cataract surgery anesthesia (00142) appeared in 4,859 disputes at a 79.07 percent provider win rate, with a median QPA of $311.80 and a median award of $2,156.00. Knee procedure anesthesia (01400) had 4,518 disputes (80.99 percent won; $396.31 and $2,205.00), shoulder anesthesia (01630) 3,266 (82.52 percent; $470.97 and $2,574.00), lower leg, ankle, and foot anesthesia (01480) 2,655 (81.54 percent; $352.91 and $2,736.00), and hand and forearm anesthesia (01810) 3,296 (81.04 percent; $238.96 and $1,552.50). Nose and sinus anesthesia (00160) had 3,217 disputes (80.11 percent; $470.91 and $2,682.21), and total knee replacement anesthesia (01402) 1,601 (83.45 percent; $620.56 and $5,222.80).
Nerve block and spinal injection codes
The injection codes are the biggest outliers. Prone-position nerve block anesthesia (01992) appeared in 3,774 disputes (83.86 percent won) with a median QPA of $320.33 and a median award of $7,000.00. Among the injections themselves, a brachial plexus nerve block (64415) had 1,981 disputes (82.19 percent won; $108.07 and $2,062.50), a femoral nerve block (64447) 1,783 (84.16 percent; $86.81 and $5,000.00), a transforaminal epidural injection (64483) 2,166 (87.72 percent; $236.25 and $12,555.00), and its added level (64484) 1,776 (86.96 percent; $114.42 and $10,000.00). Lumbar facet joint injections at the first level (64493) and second level (64494) had 1,712 disputes (86.1 percent; $229.95 and $14,000.00) and 1,622 (85.32 percent; $135.77 and $13,000.00). A few high-volume filers can move medians this size, so check the state and payer cut at idrexplorer.com before pricing.
Monitoring, vein, and other lines
Monitoring codes decide at many times their benchmarks. Limited-muscle electromyography (95870) appeared in 2,719 disputes (84.99 percent won) with a median QPA of $34.26 and a median award of $4,800.00, somatosensory evoked potential testing (95938) in 2,499 (84.91 percent; $58.97 and $2,560.00), and continuous intraoperative monitoring billed from outside the operating room (95941) in 1,882 (88.52 percent; $203.64 and $3,550.00). Vein ablation (36475) appeared in 2,221 disputes with an 84.51 percent provider win rate. Lido IDR prices each of these codes against the decided results by payer and state before filing for a flat fee per arbitration.
Price your anesthesia and procedure codes against the record
Lido IDR checks each code by payer and state against the decided results, and files for a flat fee per arbitration. Talk to an IDR specialist.