Summary & Overview
CPT 4095F: Performance/Reporting Measure
CPT code 4095F is listed as a CPT performance/reporting measure with no narrative summary available in the source description. These types of CPT codes are used for documenting quality measures or clinical observations in administrative and clinical workflows and can affect reporting, quality programs, and payer reconciliation nationally. This publication addresses the national relevance of CPT code 4095F, noting its role in documentation and reporting rather than representing a direct billable procedure.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of what the code represents, the expected service type and site when available, and guidance on where to find missing metadata. The report outlines what to expect in benchmarking and policy contexts where performance/reporting CPT codes are used, and it highlights common gaps in available public descriptions.
This material is intended to give billing and compliance teams, coders, and policy analysts a concise national-level summary of CPT code 4095F, including the practical implications for documentation and reporting. Data not available in the input is noted explicitly where metadata is missing.
Billing Code Overview
CPT code 4095F has no summary available in the source description. Based on the code designation, this entry represents a CPT performance/reporting measure rather than a traditional procedure code. Service type: Data not available in the input. 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 otolaryngology or oral and maxillofacial surgery clinic with a small benign mucosal lesion or recurrent mucous cyst on the lip or oral mucosa. The procedure is a minor diagnostic or therapeutic excisional biopsy performed under local anesthesia in an office procedure room or ambulatory surgical center. The clinical workflow includes pre-procedure consent and focused history, topical or local anesthetic administration, surgical excision of the lesion with hemostasis, specimen labeling and submission to pathology, and brief post-procedure observation with wound care instructions. Patients commonly have bleeding controlled with direct pressure or cautery, receive oral analgesics, and are discharged the same day with follow-up for pathology results and wound check.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, Separately Identifiable E/M Service by the Same Physician on the Day of a Procedure | Use when a distinct evaluation occurs on the same day as a minor office surgical procedure. |
59 | Distinct Procedural Service | Use when two procedures performed on the same day are distinct and not typically reported together.
51 | Multiple Procedures | Use when multiple procedures are billed by the same provider on the same day (subject to payer-specific multiple procedure rules).