Summary & Overview
CPT 4301F: Unknown CPT Performance/Measure
CPT code 4301F is a CPT-designated billing entry for which no clinical summary is available in the source input. As a CPT code, it is part of the Current Procedural Terminology coding system used nationally to classify clinical services and measures. Understanding and documenting CPT codes matters for consistent clinical reporting, quality measurement, and claims processing across payers. Key national payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what 4301F represents as provided, the limitations of available descriptive data, and guidance on the types of benchmarks and policy or clinical context typically relevant to CPT performance or measure codes. Where source details are missing, this publication identifies the absent fields and indicates that additional clinical description, service setting, and payer-specific coverage rules are not available in the input.
Billing Code Overview
CPT code 4301F has no summary available in the source description. Based on the code identifier, this entry represents a CPT performance/measure-related code with an undefined clinical description.
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Service type: Data not available in the input.
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Typical site of service: Data not available in the input.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to a gastroenterology clinic or ambulatory surgical center with symptoms of dysphagia, recurrent food impaction, or suspected esophageal stricture. After evaluation including history, physical exam, and review of prior studies (barium swallow, endoscopy), the patient is scheduled for an esophagogastroduodenoscopy (EGD) with diagnostic assessment and possible therapeutic intervention. The clinical workflow includes pre-procedure consent and assessment, moderate sedation or anesthesia per facility protocols, endoscopic evaluation of the esophagus, stomach, and duodenum, and targeted therapy if indicated (for example dilation of benign esophageal stricture, removal of impacted bolus, biopsy of suspicious lesion). Post-procedure recovery and discharge instructions are provided. Typical sites of service are the outpatient endoscopy suite, ambulatory surgery center, or hospital operating room for higher-risk patients.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service on the same day as a procedure | Use when a separately documented evaluation and management service is provided on the same day as the procedure and meets E/M documentation and medical necessity requirements. |
59 | Distinct procedural service | Use to indicate a distinct procedural service performed on a separate anatomic site or separate session from other procedures on the same day.
76 | Repeat procedure by same physician | Use when an exact same procedure is repeated later the same day by the same physician.
77 | Repeat procedure by another physician | Use when the same procedure is repeated the same day by a different physician.
51 | Multiple procedures | Use to indicate multiple procedures performed at the same session when more than one procedure is reported.
52 | Reduced services | Use when the service provided was partially reduced or eliminated at the physician's discretion.
53 | Discontinued procedure | Use when the procedure was started but discontinued due to extenuating circumstances or patient choice.
22 | Unusual procedural services | Use when work required to provide the procedure is substantially greater than typically required; documentation must support increased work.
24 | Unrelated E/M service by the same physician during a postoperative period | Use when an unrelated E/M service is provided during the global period and is not related to the surgical procedure.
57 | Decision for surgery | Use on the E/M code when the E/M visit results in the decision for surgery; appended to the E/M service when appropriate.
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RG0100X | Gastroenterology | Specialists who commonly perform diagnostic and therapeutic upper endoscopy and dilation procedures. |
2080P0207X | General Surgery | Surgeons who perform endoscopic procedures in operative settings or for complex esophageal interventions.
207RH0000X | Pediatric Gastroenterology | For pediatric patients requiring similar endoscopic evaluation and interventions.
363L00000X | Anesthesiology | Providers who deliver deep sedation or anesthesia for endoscopic procedures when indicated.
261QM0800X | Nurse Practitioner | Advanced practice clinicians who may perform or assist in endoscopy under appropriate privileging and supervision.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K22.21 | Stricture and stenosis of esophagus | Common indication for diagnostic EGD with dilation or assessment of luminal narrowing. |
K22.2 | Diverticulum of esophagus | May be evaluated and treated endoscopically if symptomatic or causing food impaction.
K22.0 | Achalasia of esophagus | Endoscopic evaluation is part of diagnostic workup; therapeutic interventions like pneumatic dilation or myotomy may follow.
K21.9 | Gastro-esophageal reflux disease without esophagitis | Chronic GERD can lead to strictures or Barrett mucosa assessed during EGD.
R13.10 | Dysphagia, unspecified | Symptom prompting esophagogastroduodenoscopy to identify obstructive or motility causes.
T18.128A | Foreign body in other parts of gastrointestinal tract, initial encounter | Endoscopic removal of impacted food bolus or foreign body in the esophagus is a common therapeutic use.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
43235 | Esophagogastroduodenoscopy, flexible, transoral; diagnostic, with or without collection of specimen(s) by brushing or washing | Often performed prior to or as the diagnostic component of therapeutic upper endoscopy interventions. |
43249 | Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus, balloon dilation (includes pre- and post-dilation endoscopy) | Commonly performed when endoscopic dilation is required for benign or malignant strictures.
43239 | Esophagoscopy, rigid or flexible, with removal of foreign body | Performed when impacted food bolus or foreign body in the esophagus requires endoscopic extraction.
43251 | Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple | Biopsy codes are billed when mucosal sampling is performed during the EGD portion of the procedure.
43246 | Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method | Used when hemostasis is required during endoscopic evaluation of bleeding lesions in the upper GI tract.
99153 | Moderate sedation services provided by a physician anesthesiologist or other qualified health care professional, intra-service time >15 minutes | Billed when moderate sedation is provided in conjunction with the procedure and is reported separately per payer policy.