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CPT Modifier -21 Usage and Reimbursement


Description:
Prolonged Evaluation and Management Services


Usage: Modifier 21 is used when the face-to-face service provided is prolonged or otherwise greater than usually required for the highest level of evaluation and management (E&M) service within a given category. Modifier 21 is applicable only for the following E&M codes 99205, 99215, 99223, 99233, 99245, 99255, 99263, 99285, 99303, and 99313

Modifier -21 is used to report services performed that take more time or are greater than the highest level E/M code in a category.

Provider needs to submit a report with the claim.

Should not be reported with Non-physician service(s).

Reimbursement:

Modifier 21 is no longer valid for use. Please see codes 99354-99359 for prolonged services.

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