CPT 61559: Federal IDR outcomes
Extensive removal of skull bone with bone grafts for multiple skull suture defects to restore skull shape
In 2023 Q1–2025 Q4, the provider or facility offer prevailed in 70.6% of 34 determined Federal IDR dispute line items for CPT 61559. The median prevailing offer was 5.66x the QPA (25th–75th percentile 1.00x–16.52x; n = 31).
Determined line items
34
2023 Q1–2025 Q4 · 0 split decisions excluded
Provider win rate
70.6%
n = 34 · 2023 Q1–2025 Q4
Median payment vs QPA
5.66x
middle half 1.00x–16.52x · n = 31 · 2023 Q1–2025 Q4
Median days to decision
–
not pooled across years (CMS changed the definition in 2025)
Dollar amounts
Fewer than 30 line items with dollar amounts in 2024 Q3–2025 Q4; not shown.
Dollar amounts by period
| Period | Line items with $ | Total awarded | Total QPA | Above QPA | Median award | Median QPA | Award ×QPA ($-weighted) |
|---|---|---|---|---|---|---|---|
| 2025 Q1–Q4 | Fewer than 30 line items with dollar amounts; not shown. | ||||||
| 2024 Q3–Q4 | Fewer than 30 line items with dollar amounts; not shown. | ||||||
| 2024 Q3–2025 Q4 | Fewer than 30 line items with dollar amounts; not shown. | ||||||
| 2023 Q1–2024 Q2 | Not available (see methodology). | ||||||
From the CMS QPA and Offers file (see above). Award ×QPA here is total awarded ÷ total QPA, so large claims weigh more than in the per-line median ratio.
By period
| Period | Line items | Win % | Median ×QPA | 25th–75th | Ratio n | Median days |
|---|---|---|---|---|---|---|
| 2025 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2024 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–Q4 | Fewer than 30 determined line items; not shown. | |||||
| 2023 Q1–2025 Q4 | 34 | 70.6% | 5.66x | 1.00x–16.52x | 31 | not pooled |
Line items = determined dispute line items (n). Win rate excludes split decisions and includes default decisions. Ratio n = line items reporting a payment-to-QPA ratio. Days are business days as reported by CMS (2023–2024: from IDR entity assignment; 2025: from initiation) and are never pooled.
By state
No row has 30 or more determined line items in 2025 Q1–Q4.
By specialty
No row has 30 or more determined line items in 2025 Q1–Q4.
Section: Surgery (10004–69990)
FAQ
What is the Federal IDR provider win rate for CPT 61559?
In 2023 Q1–2025 Q4, the provider or facility offer was selected in 70.6% of 34 determined dispute line items for CPT 61559. Split decisions are excluded from the denominator and default decisions are included. Withdrawn, settled and ineligible disputes are not in the CMS data.
How do Federal IDR payments compare with the QPA for CPT 61559?
In 2023 Q1–2025 Q4, the median prevailing offer was 5.66x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.00x to 16.52x (n = 31 line items). This uses the CMS field Prevailing Party Offer as % of QPA, where 1.00x equals the QPA.