CPT 4179F Tamoxifen/Aromatase Inhibitor Reimbursement | OpenPayer

Summary & Overview

CPT 4179F: Prescription of Tamoxifen or Aromatase Inhibitor for Breast Cancer

CPT code 4179F denotes the prescription of tamoxifen or an aromatase inhibitor for female patients aged 18 or older with breast cancer. This preventive and therapeutic measure addresses estrogen-driven tumor growth by either blocking estrogen receptors or inhibiting estrogen synthesis, and it is commonly documented as part of longitudinal breast cancer management. Nationally, the code is an important quality and treatment indicator because endocrine therapy significantly reduces recurrence risk in hormone-receptor–positive breast cancer and is widely used across oncology and primary care settings.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for endocrine therapy, typical sites of service, and what the code captures in administrative data. The publication outlines benchmarking considerations and policy-relevant items such as coverage expectations and measure reporting, and it situates CPT code 4179F within care pathways for hormone-receptor–positive breast cancer. Content is aimed at billing managers, quality leads, and policy analysts seeking a national view of how this code is used for tracking endocrine therapy prescribing and related quality measurement.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 4179Fendocrine therapybreast cancertamoxifenaromatase inhibitoroncology outpatientquality measureprescription documentation

Billing Code Overview

CPT code 4179F documents that a provider prescribes tamoxifen or an aromatase inhibitor to a female patient age 18 or older with breast cancer. The measure reflects prescription of endocrine therapy aimed at blocking estrogen activity—tamoxifen acts as an estrogen receptor modulator, while aromatase inhibitors reduce estrogen synthesis.

Service Type

Pharmacologic management / prescription of hormone therapy

Typical Site of Service

Outpatient oncology clinic, including medical oncology or breast cancer specialty clinics
Office-based primary care when prescribing endocrine therapy as part of ongoing cancer care

Clinical & Coding Specifications

Clinical Context

A typical patient is a female aged 18 years or older with a histologically confirmed estrogen receptor–positive breast cancer who is being prescribed endocrine therapy to reduce risk of recurrence or progression. The oncology clinician (medical oncologist or breast surgeon in a multidisciplinary clinic) conducts a medication counseling visit that includes review of pathology, menopausal status, drug selection between tamoxifen or an aromatase inhibitor (e.g., anastrozole, letrozole, exemestane), dosing, duration (typically 5–10 years), side-effect profile, interactions, and adherence strategies. The clinician documents indication, informed consent for therapy, baseline assessments (menstrual/menopausal history, bone density considerations for aromatase inhibitor use), and follow-up plan. Typical site of service is an outpatient oncology clinic or ambulatory surgery center for perioperative oncology visits; prescriptions are sent electronically to the pharmacy or outpatient infusion/oncology pharmacy is notified if needed. In the clinical workflow this counseling and prescription often follows surgical pathology review, staging visits, or adjuvant therapy planning, and is coordinated with primary care for comorbidity management and with gynecology or endocrinology when needed for menopausal symptom management or bone health monitoring.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure	Use when a separate E/M visit is documented the same day as a procedural service related to prescribing or counseling about endocrine therapy.

CPT 4256F: Anesthesia for Less Than One Hour

CPT-4187F-DISEASE-MODIFYING-ANTIRHEUMATIC-DRUG-THERAPY

CPT 4187F: Disease Modifying Antirheumatic Drug Therapy

CPT-4561F-ASPIRIN-WITHIN-24-HOURS-BEFORE-ANESTHESIA-FOR-CORONARY-STENT

CPT 4561F: Aspirin within 24 Hours Before Anesthesia for Coronary Stent Patients

CPT-4060F-NO-SUMMARY-AVAILABLE

CPT 4060F: No Summary Available

CPT-4014F-PERFORMANCE-MEASURE-QUALITY-REPORTING

CPT 4014F: Performance Measure for Clinical Quality Reporting

CPT-4188F-QUALITY-MEASURE-REPORTING

CPT 4188F: Clinical Quality Measure Reporting

CPT-4047F-UNDEFINED-SERVICE

CPT 4047F: Unspecified Service (No Summary Available)

CPT-4301F-UNKNOWN-PERFORMANCE-MEASURE

CPT 4301F: Unknown CPT Performance/Measure

CPT-4510F-PROCEDURAL-OR-PERFORMANCE-MEASURE

CPT 4510F: Procedural or Performance Measure

CPT-4000F-ASTHMA-TOBACCO-EXPOSURE-COUNSELING

CPT 4000F: Brief Counseling for Tobacco Exposure in Asthma

Showing 1–10 of 175

Taxonomy Code	Specialty	Notes
`207RG0100X`	Medical Oncology	Primary specialty prescribing endocrine therapy for breast cancer.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C50.911`	Malignant neoplasm of unspecified site of right female breast	Primary diagnosis for prescribing endocrine therapy when tumor is in the right breast.

C50.912 | Malignant neoplasm of unspecified site of left female breast | Primary diagnosis for prescribing endocrine therapy when tumor is in the left breast.

C50.919 | Malignant neoplasm of unspecified site of unspecified female breast | Use when side is unspecified and endocrine therapy is indicated.

C50.521 | Malignant neoplasm of upper-inner quadrant of right female breast | Site-specific breast cancer diagnosis relevant to adjuvant endocrine therapy decisions.

C50.522 | Malignant neoplasm of upper-inner quadrant of left female breast | Site-specific breast cancer diagnosis relevant to adjuvant endocrine therapy decisions.

Z85.3 | Personal history of malignant neoplasm of breast | Used for surveillance patients with prior breast cancer who may be prescribed extended endocrine therapy for recurrence risk reduction.

N95.1 | Postmenopausal bleeding | Relevant as a baseline or concurrent diagnosis to document menopausal status or evaluate symptoms when considering tamoxifen vs aromatase inhibitor therapy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common E/M code used for medication counseling and prescription of tamoxifen or an aromatase inhibitor in an outpatient clinic.

99214 | Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes | Used when counseling and decision-making for endocrine therapy are moderately complex and require more time.

96372 | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular | May be used if concurrent injectable supportive medications are administered during the visit (e.g., supportive agents), though not for oral endocrine prescriptions.

77080 | Dual-energy X-ray absorptiometry (DEXA) scan, bone density study | Commonly ordered before or during aromatase inhibitor therapy to monitor bone mineral density and manage osteoporosis risk.

99441 | Telephone evaluation by a physician or other qualified healthcare professional, 5-10 minutes of medical discussion | May be used for brief telephonic counseling or prescription management related to endocrine therapy.

OpenPayer