CPT 41100 Tongue Excisional Biopsy Reimbursement | OpenPayer

Summary & Overview

CPT 41100: Excisional Tongue Biopsy, Anterior Two Thirds

CPT code 41100 designates an excisional biopsy of the anterior two thirds of the tongue, used to obtain diagnostic tissue from lesions or suspicious areas on the tongue. Nationally, this code is relevant to otolaryngology, oral surgery, and head and neck oncology services because timely and accurate tissue diagnosis guides treatment decisions and staging. Payers commonly involved in coverage and reimbursement for this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise overview of what CPT code 41100 represents, typical clinical settings and service types, and the key considerations for coding and claims in a national context. The publication covers benchmarking items such as usual sites of service and payer mix, summarizes clinical context for when an excisional tongue biopsy is performed, and highlights administrative details that affect billing and documentation. Data not available in the input is noted where applicable, and the content focuses on the code meaning, coverage landscape, and operational context for stakeholders across the health system.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 41100tongue biopsyexcisional biopsyhead and neck surgeryambulatory surgery

Billing Code Overview

CPT code 41100 describes a surgical procedure in which the clinician makes an incision in the anterior two thirds of the tongue and excises affected tissue for the purpose of biopsy. This is a tongue biopsy with excision intended to obtain diagnostic tissue when lesions or suspicious areas involve the front portion of the tongue.

Service type: Surgical biopsy/excisional procedure
Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in an office setting with appropriate surgical capabilities

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents to an otolaryngology clinic with a persistent, non-healing ulcerative lesion on the anterior two-thirds of the tongue noted on exam. The patient reports mild pain, intermittent bleeding, and a recent change in lesion size. The clinician performs a focused head and neck exam, documents lesion characteristics (size, location, induration, mobility), and reviews medical history and anticoagulation status. After informed consent, the patient is taken to a procedure room or outpatient surgery suite where local anesthesia (with or without sedation) is administered. The provider makes an incision in the anterior two-thirds of the tongue and excises the lesion or affected tissue for diagnostic biopsy, controlling hemostasis and closing with absorbable sutures as indicated. Specimens are labeled and sent to pathology. Post-procedure instructions include airway precautions, diet modifications, analgesia plan, and follow-up for pathology results. Typical sites of service are the ambulatory surgical center, hospital outpatient department, or office-based procedure room depending on complexity and anesthesia needs.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal (primary) procedure	Use when this code represents the primary service performed during the encounter
`22`

CPT 41108: Biopsy, Incision and Excision of Floor of Mouth Tissue

CPT-41145-TOTAL-GLOSSECTOMY-UNILATERAL-NECK-DISSECTION

CPT 41145: Total Glossectomy with Unilateral Neck Dissection

CPT-41110-TONGUE-LESION-EXCISION

CPT 41110: Excision of Lesion from Tongue

CPT-41116-FLOOR-OF-MOUTH-LESION-EXCISION

CPT 41116: Excision of Lesion, Floor of Mouth

CPT-41113-EXCISION-LESION-POSTERIOR-TONGUE

CPT 41113: Excision of Lesion, Posterior One-Third of Tongue

CPT-41153-GLOSSECTOMY-FLOOR-OF-MOUTH-SUPRAHYOID-NECK-DISSECTION

CPT 41153: Glossectomy with Floor of Mouth Resection and Suprahyoid Neck Dissection

CPT-41112-TONGUE-LESION-EXCISION-ANTERIOR-TWO-THIRDS

CPT 41112: Excision of Lesion, Anterior Two-Thirds of Tongue

CPT-41105-POSTERIOR-TONGUE-BIOPSY-EXCISION

CPT 41105: Posterior Tongue Biopsy, Excisional

CPT-41115-LINGUAL-FRENUM-EXCISION-BASE-OF-TONGUE

CPT 41115: Excision of Lingual Frenum at Base of Tongue

CPT-41140-TOTAL-GLOSSECTOMY-WITH-TRACHEOSTOMY

CPT 41140: Total Glossectomy with Tracheostomy

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Taxonomy Code	Specialty	Notes
`2086S0111X`	Otolaryngology (ENT)	Common specialty performing tongue biopsies and oral cavity surgery
`207L00000X`	Oral and Maxillofacial Surgery	Performs excisions, complex tongue resections, and reconstruction
`207Q00000X`	General Surgery	May perform oral cavity biopsies in hospital settings
`207X00000X`	Plastic and Reconstructive Surgery	Involved when complex closure or reconstruction is needed
`363L00000X`	Pathology (Clinical & Anatomic)	Processes and interprets biopsy specimens (clinical relationship rather than procedure performer)

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K13.0`	Leukoplakia of oral mucosa, including tongue	Premalignant white plaque prompting biopsy of the tongue
`K13.1`	Erythroplakia of oral mucosa	Red velvety lesions of tongue with high dysplasia risk requiring excisional biopsy
`C02.9`	Malignant neoplasm of tongue, unspecified	Suspicion of tongue cancer warranting diagnostic excision and pathology
`R22.9`	Localized swelling, mass and lump, unspecified	Palpable tongue mass necessitating tissue diagnosis
`K14.8`	Other diseases of tongue	Includes inflammatory or other lesions that may need biopsy to establish diagnosis

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`40490`	Biopsy, lip; excision of lesion or tissue, single or multiple	Alternative oral cavity biopsy code when lesion is on lip rather than tongue; may be performed in the same clinical workflow for adjacent lesions
`41105`	Excision of lesion of tongue, partial glossectomy; hemiglossectomy	More extensive surgical resection when lesion requires partial glossectomy rather than localized biopsy
`41010`	Biopsy, oral mucosa (including tangential and punch biopsy techniques)	Less extensive biopsy techniques that may be used for small, superficial tongue lesions
`99100`	Anesthesia for procedures performed in remote location of the hospital (e.g., radiology, MR)	May be reported if additional anesthesia resources are required in a different setting; used per payer rules
`99213`	Office or other outpatient visit for established patient, moderate complexity	Typical pre- or post-procedure office visit code for evaluation and management related to the biopsy procedure

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