Answers / The surgery center record
The surgery center IDR record
In the 2025 public use files, 162,740 disputes with a line billed at a surgery center (place of service 24) were resolved under the No Surprises Act, and providers won 83.05 percent. Volume was 2.67 times the 2024 level and the median decision took 31 days. Anesthesia codes appeared in 65.04 percent of the disputes, three filer domains brought 42.67 percent, and Arizona, New Jersey, and Texas together produced 55.12 percent.
Volume, speed, and default decisions
Surgery center disputes numbered 5,034 in 2023, 61,047 in 2024, and 162,740 in 2025. Quarterly volume climbed from 5,438 in the first quarter of 2024 to 28,396 in the fourth, then ran 32,078, 42,793, 43,160, and 44,709 through 2025. Leaving out default decisions, providers won 82.32 percent in 2025; counting them, 83.05. Without the defaults, providers asked a median of 15.35 times the QPA and plans offered a median of 1.05 times, and winning offers across all disputes came in at a median of 15.13 times. That blended figure hides a split. Counted by line item, winning offers on anesthesia codes ran at a median 6.85 times the QPA, and on every other code 39.55 times. A median dispute took 57 days to decide in 2023, 47 in 2024, and 31 in 2025, and default decisions made up 14.74 percent of 2025 disputes against 20.76 percent in 2024.
What anesthesia and procedure lines pay
Every figure below uses lines billed at a surgery center in 2025 that report a QPA and offers. Screening colonoscopy anesthesia (00812) had a median QPA of $245.43 and a median decided award of $1,755.00 across 32,471 lines, upper endoscopy anesthesia (00731) $270.82 and $1,988.00 across 9,699, lower endoscopy anesthesia (00811) $272.29 and $1,989.00 across 7,940, and the combined code (00813) $314.21 and $2,320.50 across 9,591. Cataract surgery anesthesia (00142) had $311.80 and $2,156.00 across 6,160, and knee procedure anesthesia (01400) $396.31 and $2,205.00 across 4,986. Prone-position nerve block anesthesia (01992) stands out at $320.33 against $7,000.00 across 3,589 lines. The 00812 award was $1,133.62 in 2023, $2,376.00 in 2024, and $1,755.00 in 2025, while its QPA moved only from $226.80 to $245.43. Outside anesthesia, limited-muscle electromyography (95870) had a median QPA of $34.26 and a median decided award of $4,800.00 across 3,183 lines, and a lumbar facet joint injection (64493) $229.95 and $14,000.00 across 1,142.
Filers and payers
Three filer domains brought 69,447 of the 162,740 disputes (42.67 percent), and five brought 92,402 (56.78 percent), out of 183 filer domains in all. Practices with fewer than 20 employees filed 55,500 disputes (34.1 percent), those with 51 to 100 employees 46,541 (28.6 percent), and those with 20 to 50 employees 31,999 (19.7 percent). On the plan side, Blue Cross and Blue Shield of Texas appeared in 9,805 disputes; providers won 94.5 percent of them and 35.5 percent ended in default decisions. EmblemHealth had 3,869 disputes (92.7 percent won, 41.6 percent defaults), while Louisiana Blue was the weak spot at 3,678 disputes and a 52.4 percent provider win rate. Winning offers came in at a median of 38.4 times the QPA where Blue Cross Blue Shield of Arizona was the plan, 23.65 for Anthem, 14.12 for Aetna, 12.95 for UnitedHealthcare, 8.08 for MultiPlan, and 6.45 for Cigna.
Plan types, states, and state law
Self-insured employer plans were the plan type in 122,344 disputes (75.2 percent; 83.4 percent won), fully insured group plans in 16,852 (10.4 percent), and non-federal government plans in 9,978 (6.1 percent). Individual-market disputes ended in default decisions 21.7 percent of the time. Federal rules apply to self-insured plans in every state, while many states run their own process for fully insured plans, which is one reason the federal files lean toward the first group. Arizona produced 36,549 disputes (22.5 percent), New Jersey 30,159 (18.5), Texas 23,002 (14.1), Florida 13,073 (8.0), Missouri 12,043 (7.4), New York 9,022 (5.5), California 7,753 (4.8), and Louisiana 5,802 (3.6, with a 59.1 percent provider win rate). Each cut is available at idrexplorer.com; Lido IDR prices every offer from it before filing for a flat fee per arbitration.
Price your surgery center lines against the record
Lido IDR prices each anesthesia, surgeon, and procedure line by payer, state, and code against the published decisions, and files for a flat fee per arbitration. Talk to an IDR specialist.