Summary & Overview
CPT 4046F: Prophylactic Antibiotic Administration Within Four Hours Prior to Incision
CPT code 4046F denotes documented administration of prophylactic antibiotics within four hours before surgical incision or during the surgical procedure. This single-line performance reporting code captures a key element of surgical infection prevention and is used in perioperative quality measurement and claims documentation. Nationally, consistent reporting of 4046F supports tracking of adherence to antibiotic timing standards, which are tied to surgical-site infection prevention efforts and performance reporting programs.
Key payers considered in analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical service settings (operating room and surgical suites), and common uses of the code in quality reporting and claims workflows. The publication outlines benchmarks and reporting expectations where available, summarizes relevant policy and coding guidance, and highlights operational considerations for documentation and claims submission.
The content is aimed at billing managers, compliance officers, clinical quality teams, and revenue cycle professionals seeking to understand when 4046F is applied, how it fits into perioperative care documentation, and implications for national performance measurement.
Billing Code Overview
CPT code 4046F is reported when a provider documents administration of prophylactic antibiotics within four hours prior to a surgical incision or during the surgical procedure. This code denotes perioperative antibiotic prophylaxis tied to a surgical encounter.
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Service type: Perioperative prophylactic medication administration
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Typical site of service: Operating room or other surgical setting where the procedure is performed
Clinical & Coding Specifications
Clinical Context
A 52-year-old male is scheduled for an elective inguinal hernia repair under general anesthesia. Per surgical prophylaxis protocol, the operating surgeon documents administration of a single dose of cefazolin given intravenously 30 minutes prior to skin incision. The patient arrives on the day of surgery after standard preoperative assessment, including allergy review and medication reconciliation. In the operating room, anesthesia confirms IV access, and nursing documents time and drug, ensuring the antibiotic was given within four hours prior to incision. The prophylactic dose is intended to reduce surgical site infection risk associated with the clean-contaminated procedure. Postoperative documentation in the operative report and medication administration record references the antibiotic administration timing relative to the incision to support reporting of 4046F for quality/reporting measures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
24 | Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period | Use when an unrelated E/M service occurs during the global period of the surgery where prophylactic antibiotic documentation is also present. |
25 |