Summary & Overview
CPT 41105: Posterior Tongue Biopsy, Excisional
CPT code 41105 denotes a surgical excision of tissue from the posterior one third of the tongue for biopsy. This code captures a focused diagnostic procedure used when tissue from the base or posterior tongue is required to establish a histologic diagnosis. Nationally, accurate coding for this procedure matters for claims processing, quality measurement, and appropriate tracking of head and neck diagnostic services.
Key payers in typical coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find practical benchmarks and clinical context for code use, including common service locations and the clinical rationale for posterior tongue biopsy. The publication outlines billing and documentation considerations relevant to payers listed above and highlights typical payer coverage patterns and authorization touchpoints.
This analysis provides: a concise description of the procedure and when it is used; expected sites of service; alignment with commonly billed head and neck surgical services; and a national perspective on how payers approach coverage and claims adjudication for this diagnostic excision. Data not available in the input is noted where specific payer policy details, associated taxonomies, and ICD-10 diagnosis pairings would normally be included.
Billing Code Overview
CPT code 41105 describes a surgical procedure in which the provider makes an incision in the posterior one third of the tongue and excises the affected tissues for the purpose of biopsy. This procedure is a diagnostic excision of posterior tongue tissue intended to obtain tissue for histopathologic examination.
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Service type: Surgical biopsy of the posterior tongue
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Typical site of service: Ambulatory surgical center or hospital operating room; may also be performed in a procedure room when appropriate
Clinical & Coding Specifications
Clinical Context
A 62-year-old male presents to the otolaryngology clinic with a 4-week history of persistent throat pain and a non-healing ulcer on the posterior one-third of the tongue noted on exam. The surgeon performs a focused procedure under local anesthesia with monitored sedation in an outpatient minor procedure room: a posterior tongue incision and excisional biopsy of the suspicious lesion to establish histopathology. The workflow includes pre-procedure consent and history, review of anticoagulation, marking the lesion, administration of local anesthetic (or conscious sedation if clinically indicated), incision in the posterior tertiary tongue tissue, excision of the targeted tissue for biopsy, hemostasis, specimen labeling and submission to pathology, brief recovery monitoring, and discharge with wound care instructions and follow-up to review pathology results.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the operative report documents substantially greater work or complexity than typical for an excisional biopsy of the posterior tongue. |
25 | Significant, separately identifiable E/M service | Use when a separate evaluation and management visit on the same day is medically necessary and documented. |