Summary & Overview
CPT 4100F: Clinical Performance Measure
CPT code 4100F is a CPT Category II reporting code associated with clinical performance measurement. Category II codes are used to document services, tests, or clinical observations that support performance measurement and quality improvement rather than to report billable procedures for reimbursement. Nationally, Category II reporting codes like 4100F matter because they feed quality metrics, value-based payment models, and population health monitoring systems.
Payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of what 4100F denotes, how Category II codes are used across payers, and context on where such a measure fits in clinical workflows and reporting programs. The publication outlines typical benchmarking and reporting considerations, common clinical contexts where a Category II item could apply, and references to payer coverage patterns and quality program alignment.
This summary is intended for clinicians, billing staff, and policy analysts seeking a concise national-level view of CPT Category II code 4100F, including its role in performance reporting and the payer landscape relevant to quality measurement.
Billing Code Overview
CPT code 4100F has no summary available in the source description. Based on the code label, this entry represents a discrete clinical reporting or measurement item within the CPT Category II structure used for performance and quality reporting. 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 surgical clinic or ambulatory surgery center with a small cutaneous lesion or suspected non-melanoma skin cancer on the trunk or extremity. The patient has localized disease suitable for office-based excision under local anesthesia. The clinical workflow includes pre-procedure evaluation (history, medication review, consent), marking and local anesthesia administration, lesion excision with appropriate margins, hemostasis, specimen handling for pathology if indicated, layered wound closure, and post-procedure instructions and follow-up for wound check and pathology review. Typical sites of service are dermatology clinic, outpatient surgical center, or physician office-based procedure room. Patient factors such as anticoagulation, diabetes, or immunosuppression may alter peri-procedural planning and hemostasis management. Follow-up visit scheduling and pathology result communication complete the care episode.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when a distinct E/M visit is provided on the same day as the procedure and documentation supports a separate service |
57 | Decision for surgery | Use when the E/M on the day resulted in the initial decision to perform a major surgical procedure