Summary & Overview
CPT 1055F: Category II Performance Measure, No Summary Available
CPT code 1055F is a CPT Category II performance measure code. Category II codes are alphanumeric entries used to track performance metrics and quality reporting rather than billable procedures. As such, 1055F represents a reporting element rather than a standalone clinical service, and it is used in administrative and quality-measure workflows that support national performance monitoring and pay-for-performance programs. National payers and programs that engage in quality reporting recognize Category II codes for tracking compliance and outcomes; typical payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. This summary provides readers with the clinical and administrative context for 1055F, clarifies the code’s role as a performance measure, and identifies where more detailed procedural or diagnostic information is not available in the input. Readers will find an overview of the code’s purpose, which payers commonly use Category II reporting, and guidance on the types of benchmarks and policy updates usually associated with Category II measures. Data not available in the input is explicitly noted where descriptive elements such as service type, site of service, related ICD-10 diagnoses, modifiers, and associated taxonomies would otherwise appear.
Billing Code Overview
CPT code 1055F is a CPT Category II performance measure code used to indicate that no summary was found for the code in the provided description. The code is recorded as a performance or quality measure entry rather than a discrete procedural service.
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Service Type: Data not available in the input.
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Typical Site of Service: Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient dermatology or minor procedure clinic with a small, symptomatic, or cosmetically concerning skin lesion (e.g., benign cyst, lipoma, epidermal inclusion cyst, or small subcutaneous mass). The clinician evaluates the lesion, documents size, location, and clinical impression, and discusses risks and benefits of removal. Local anesthesia is administered, a small incision is made, and the lesion is excised or drained using sterile technique. Hemostasis is achieved, and the wound is closed with sutures, adhesive, or dressed for secondary intention. The patient receives post-procedure wound care instructions and a plan for pathology if the specimen is sent for analysis. Typical workflow includes pre-procedure consent and coagulation assessment as indicated, procedure documentation including lesion description and technique, and post-procedure follow-up for suture removal or pathology results. Common sites of service are outpatient office, ambulatory surgery center, and occasionally emergency department for urgent lesion drainage or excision.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure | Use when a distinct E/M visit is provided and documented in addition to the procedure |
59 | Distinct procedural service | Use to indicate a separate procedure or service performed on the same day that is not typically reported together |
51 | Multiple procedures | Use when multiple procedures are performed at the same session; list primary procedure first |
52 | Reduced services | Use when the service provided is less than described by the CPT code |
53 | Discontinued procedure | Use when the procedure was started but discontinued due to extenuating circumstances |
76 | Repeat procedure or service by same physician/provider | Use when a procedure is repeated subsequent to the original within the same session or day |
77 | Repeat procedure by another physician/provider | Use when another provider repeats the procedure on the same day |
24 | Unrelated E/M service by the same physician during a postoperative period | Use when an E/M visit unrelated to the original procedure occurs during global period |
78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period | Use for a related return to procedure room for complications |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during global period |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207Q00000X | Dermatology | Dermatologists commonly perform excisions and lesion removals |
208100000X | General Practice | Primary care physicians may perform minor skin lesion removals in office |
207P00000X | Surgery | General surgeons perform excisions of subcutaneous masses and cysts |
282N00000X | Podiatry | Podiatrists remove lesions located on the foot or ankle |
367A00000X | Family Medicine | Family physicians perform minor procedures in office settings |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L72.0 | Epidermal cyst | Common indication for excision or drainage of a symptomatic cyst |
L72.3 | Steatocystoma multiplex | Represents cystic lesions that may require removal for symptoms or cosmesis |
D23.9 | Benign neoplasm of skin, unspecified | Typical diagnosis for benign skin lesions removed electively |
L98.9 | Disorder of skin and subcutaneous tissue, unspecified | Used when a more specific diagnosis is not available at time of procedure |
R22.9 | Localized swelling, mass and lump, unspecified | Describes a palpable mass prompting excision or biopsy |
S91.311A | Laceration without foreign body of right foot, initial encounter | Example of a traumatic lesion that may require minor excision and repair |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
10120 | Incision and drainage of hematoma, seroma or fluid collection | May be performed when drainage of a post-procedure or spontaneous fluid collection is required |
11100 | Biopsy of skin, subcutaneous tissue and/or mucous membrane (single lesion) | Used when a small lesion is sampled for diagnostic purposes rather than complete excision |
11042 | Debridement; skin, subcutaneous tissue and muscle | Performed when a more extensive debridement is required beyond simple excision |
12001 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.5 cm or less | Often used for primary closure of small excision wounds when layered repair is not necessary |
88305 | Surgical pathology, gross and microscopic examination | Used when the excised specimen is submitted for histopathologic evaluation |