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Federal IDR · Code overview
Out of network Full thickness skin graft, face or extremity, CPT 15240
The denial, the code, and the path to recovery.
Out of network Full thickness skin graft, face or extremity (CPT 15240) is routinely paid below the billed charge or denied outright. Most practices treat what arrives as the amount owed. Under the No Surprises Act it is an opening offer, and federal independent dispute resolution exists to contest it. We prepare the submission, and we can file it for you.
- Code
- CPT 15240
- Body region
- face/extremity
- Typical setting
- hospital or ASC
Transfer of a full thickness skin graft to cover a defect.
What the federal record shows for CPT 15240
Source: CMS Federal IDR Public Use Files, calendar 2025. Figures describe the published federal record across all disputes for this code — not a prediction about any individual claim.
Why Full thickness skin graft, face or extremity gets paid short out of network
Anchored to the qualifying payment amount (QPA)
The plan pays Full thickness skin graft, face or extremity at its own qualifying payment amount — its median in-network rate for the area — and treats that as the answer. Under the No Surprises Act the QPA is the plan's opening anchor, not a cap, and certified IDR entities weigh several other factors against it.
Out-of-network reduction with no contract on file
With no negotiated rate for Full thickness skin graft, face or extremity (CPT 15240), the allowed amount is reduced to an out-of-network schedule that rarely reflects what the face/extremity procedure actually involves in a hospital or ASC setting.
Down-coding or documentation holds
Full thickness skin graft, face or extremity claims are frequently held or down-coded pending operative notes, then paid short once submitted — a gap federal IDR is designed to contest with the right clinical record attached.
The federal pathway to recovery
There is a defined federal pathway between a payer's underpayment and a binding arbitrated amount: an open negotiation window, an eligibility determination, a batching decision, then arbitration. Each step has a hard deadline, and missing one forfeits the claim. Sydra screens eligibility, assembles the evidence and offer, files, and tracks every deadline so a Full thickness skin graft, face or extremity claim never lapses by default.
Providers won 82% of the 65 CPT 15240 line items decided in 2025. Sydra is a capped, predictable fee — less than half of what most contingency firms charge. We file it, you keep the recovery.
Full thickness skin graft, face or extremity (CPT 15240) — common questions
Can out-of-network Full thickness skin graft, face or extremity (CPT 15240) claims go through federal IDR?
Yes. If the item or service qualifies under the No Surprises Act and open negotiation has passed without resolution, either party can initiate independent dispute resolution to contest the payment on CPT 15240.
Why is Full thickness skin graft, face or extremity underpaid out of network?
Higher complexity graft. Insurers anchor to the qualifying payment amount and apply out-of-network reductions, which is exactly what federal IDR exists to contest.
What does Sydra do with a Full thickness skin graft, face or extremity denial?
Sydra checks whether the Full thickness skin graft, face or extremity claim qualifies, assembles a compliant IDR submission with the supporting evidence and your offer, tracks every deadline, and can file it for you — for a monthly platform fee plus a small share of net recovery, capped per claim and billed only on disputes that win.
Browse all Plastic and reconstructive surgery codes, or return to the Federal IDR hub.
CPT 15240 by state
Routing and deadlines change at the state line, even for the same code and payer.
Full thickness skin graft, face or extremity denials by state
No outcome is guaranteed. Results vary by claim, payer, specialty, and documentation. Any general figures reflect the published federal record across all disputes, not a prediction about your claim. This is general information, not legal or financial advice.
Medically & clinically reviewed by Dr. John M. Abrahams, MD
Board-certified neurosurgeon and founder of Sydra · Last reviewed September 2026 · About the author
Sources
Figures reflect the published federal record across all disputes, not a prediction about any individual claim. This is general information, not legal or financial advice.