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- Modifier 57 Fact Sheet - Novitas Solutions
Modifier 57 is used to indicate an Evaluation and Management (E M) service resulted in the initial decision to perform surgery either the day before a major surgery (90 day global) or the day of a major surgery
- Modifier 57: For More Than Just Surgery - AAPC
Modifier 57 applies when the physician determines the need for any major procedure—whether surgical or non-surgical The CPT® manual doesn’t define “major” or “minor” procedures, but the Centers for Medicare Medicaid Services (CMS) does, and many payers follow CMS’s lead
- Modifier 57 Explained – 2026 Coding Guide: Decision for Surgery
Modifier 57 — formally described as “Decision for Surgery” in the AMA’s CPT® Appendix A — is one of the most consequential, and most frequently misused, modifiers in surgical billing
- Modifiers 25 and 57: A Quick Lesson - AAPC Knowledge Center
Modifier 25 is appropriate when an E M service is provided on the same day as a minor procedure (defined by Medicare as having a 0-day, 10-day, or “xxx” global period)
- Procedure Coding: When to Use The 57 Modifier - Continuum
Modifier 57 should be appended to any E M service on the day of or the day before said procedure when the E M service results in the decision to go to surgery This informs the payer that the physician determined the surgery was medically necessary
- Modifiers - Complete Listing - Novitas Solutions
When selecting the appropriate modifier to report on your claim, please ensure that it is valid for the date of service billed If more than one modifier is needed, list the payment modifiers—those that affect reimbursement directly—first
- 57 - JE Part B - Noridian
Use of this modifier will allow separate reimbursement for the surgeon's visit on the day of surgery It will not be a part of the global surgical package when reported with the modifier 57
- Comprehensive List of CPT Modifiers (2025) - Coding Ahead
In short, modifiers are the essential "fine print" that tells the complete story of a medical service beyond the base CPT code
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