modifier 21, 21 modifier

Modifier 21 | Billing Guidelines & Reimbursement (DELETED)

Modifier 21 was deleted in 2009. This was because the 21 modifier wasn’t recognized by many payers. Instead, report CPT 99354 to CPT 99359 for prolonged services.


Modifier 21 was used when the face-to-face service was prolonged or otherwise greater than normal. And only if the services was of the highest level of E&M within the category.

Billing Guidelines

The 21 modifier was used to report services taking more time, or are greater than the highest level E/M code in any given category.

  • Provider needed to submit a report with the claim.
  • This modifier could not be billed with non-physician service(s).

Modifier 21 was applicable for the following CPT codes:

  • CPT 99205;
  • CPT 99215;
  • CPT 99223;
  • CPT 99233;
  • CPT 99245;
  • CPT 99255;
  • CPT 99263;
  • CPT 99285;
  • CPT 99303; and
  • CPT 99313.

When Was Modifier 21 Deleted?

The 21 modifier was deleted in 2009 from the CPT manual. This was because many payes did not recognize it, so it was replaced with the CPT codes for prolonged services.

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