cpt modifier 21

Modifier 21 (2021)


Description: Prolonged Evaluation and Management Services

Usage: CPT 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. CPT Modifier 21 is applicable only for the following E&M codes CPT 99205, CPT 99215, CPT 99223, CPT 99233, CPT 99245, CPT 99255, CPT 99263, CPT 99285, CPT 99303, and CPT 99313


CPT 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:

CPT Modifier 21 is no longer valid for use.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

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