Can you use 24 and 57 modifiers together?

Editorial team InsuredAndMore.com Published on November 1, 2026

Yes, modifier 24 and modifier 57 can be billed together on the same Evaluation and Management (E/M) service line when a specific clinical scenario occurs.

When to Use Modifiers 24 and 57 Together

You append both modifiers to an E/M code when a patient is in the 90-day global postoperative period of one (earlier) major surgery, and during that visit, the physician evaluates the patient and makes the initial decision to perform a second, unrelated major surgery on that same day or the day prior.

Modifier 24: Indicates that the E/M service is unrelated to the first (earlier) surgery's global period.
Modifier 57: Indicates that the E/M service resulted in the decision to perform the new major surgery (90-day global period).

Real-World Example

First Event: A patient undergoes a knee replacement (major surgery with a 90-day global period) performed by Surgeon A.
Second Event: Within that 90-day window, the patient returns to Surgeon A with severe, unrelated abdominal pain.
The Decision: Surgeon A examines the patient, diagnoses acute appendicitis, and decides to perform an emergency appendectomy that same day.
Billing: On the E/M service code for that office visit, the billing team appends both Modifier 24 and Modifier 57 to explain why the visit is separate from the knee surgery global period and why it led to a new major procedure.

Can you code modifier 57 and 25 together?

No, you cannot append both modifier 25 and modifier 57 to the same Evaluation and Management (E/M) service code.

Key Differences

Modifier 25: Used for a significant, separately identifiable E/M service performed on the same day as a minor procedure (0-day or 10-day global period).
Modifier 57: Appended to an E/M service that resulted in the decision to perform a major surgery (90-day global period) within 24 hours.

Coding Rules

Mutual Exclusivity on a Single Line: You must choose one modifier based on the global period of the associated procedure. If it is a major surgery, use modifier 57. If it is a minor procedure, use modifier 25.
Global Period Match: Appending modifier 57 is specific to major surgeries, whereas modifier 25 is strictly for minor procedures or other non-major services. Using both on the same E/M code is contradictory and will result in claim rejections or denials.

What is the difference between modifiers 24 and 57 on a medical bill?

Modifier 24 and Modifier 57 are both appended to Evaluation and Management (E/M) codes during a global surgical period, but Modifier 24 is for an unrelated visit during an existing postoperative period, while Modifier 57 indicates an E/M service that resulted in the initial decision to perform a major surgery.

Core Differences

Feature	Modifier 24	Modifier 57
Purpose	Unrelated E/M service during a postoperative period.	Initial decision to perform major surgery.
Global Period Type	Can apply to major (90-day) or minor (10-day) global periods.	Restricted strictly to major surgeries with a 90-day global period.
Timing of Visit	During the recovery/post-op window after a procedure has already occurred.	On the day of or the day before a major surgical procedure.
Relationship to Surgery	Must be completely unrelated to the original procedure.	Directly results in the decision to perform the upcoming surgery.

Modifier 24: Unrelated Postoperative Care

When to use: Use when the same physician performs an E/M service during a global post-op period for a problem that is completely unrelated to the initial surgery.
Example: A patient is in the 10-day global period following a skin lesion excision and returns to the clinic with an acute sinus infection. The E/M visit for the sinus infection takes Modifier 24.
Key rule: Routine post-op care or treatment for surgical complications cannot use Modifier 24; the issue must be a distinct, separate diagnosis or problem.

Modifier 57: Decision for Major Surgery

When to use: Use when an E/M evaluation leads to the decision to perform a major surgery (90-day global period) either on the same day or the day before.
Example: A patient presents to the emergency room with severe abdominal pain; the evaluation results in a diagnosis of appendicitis and an immediate choice to operate. The initial E/M code is billed with Modifier 57.
Key rule: Do not use Modifier 57 for pre-planned or prescheduled surgeries, or for minor procedures with 0- or 10-day global periods.

You can review official guidelines via the American Academy of Professional Coders or check detailed rules through the Centers for Medicare & Medicaid Services.

When not to use modifier 57?

Never use Modifier 57 on surgical procedure codes, minor surgeries with a 0- or 10-day global period, or pre-planned procedures.

When NOT to Use Modifier 57

On Surgical Codes: Never append modifier 57 to the actual surgical or procedural code; it belongs exclusively on Evaluation and Management (E/M) codes.
For Minor Procedures: Do not use it for procedures with a 0- or 10-day global surgical period. Use Modifier 25 instead for separate E/M services on the same day as a minor procedure.
For Pre-Planned Surgeries: Avoid using it if the major surgery was scheduled or planned days or weeks in advance of the encounter.
For Routine Preoperative Visits: Do not append it when the decision to operate was already made previously and the visit is just a standard pre-op clearance evaluation.
For Staged or Multiple Sessions: Never use it on the day of surgery if the procedure is part of a planned staged or multiple-session treatment plan.
For Postoperative Evaluations: Do not apply it to routine follow-up care visits that occur during the global period of an earlier surgery.

Can you put two modifiers on one CPT code?

Yes, you can place two or more modifiers on a single CPT code.

Rules for Multiple Modifiers

Order matters: List payment or pricing modifiers first, followed by descriptive or informational modifiers (such as anatomical sites like RT or LT).
System limits: Most modern billing software and electronic claim forms accept at least two to four modifiers per code line.
Exceeding limits: If a code requires more modifiers than the insurance claim field allows, you may need to append Modifier 99 (Multiple Modifiers) to indicate that additional modifiers apply.

Practical Guide to E/M Modifiers 24, 25, and 57 – With Real-Life Examples #medicalcoding

9 related questions found

Can we code 24 and 57 modifier together?

Yes, modifier 24 and modifier 57 can be billed together on the same Evaluation and Management (E/M) service line when a specific clinical scenario occurs.

When to Use Modifiers 24 and 57 Together

Modifier 24: Indicates that the E/M service is unrelated to the first (earlier) surgery's global period.
Modifier 57: Indicates that the E/M service resulted in the decision to perform the new major surgery (90-day global period).

Real-World Example

First Event: A patient undergoes a knee replacement (major surgery with a 90-day global period) performed by Surgeon A.
Second Event: Within that 90-day window, the patient returns to Surgeon A with severe, unrelated abdominal pain.
The Decision: Surgeon A examines the patient, diagnoses acute appendicitis, and decides to perform an emergency appendectomy that same day.
Billing: On the E/M service code for that office visit, the billing team appends both Modifier 24 and Modifier 57 to explain why the visit is separate from the knee surgery global period and why it led to a new major procedure.

What is a 57 modifier used for?

Modifier 57 is used in medical coding to show that an Evaluation and Management (E/M) patient visit resulted in the initial decision to perform a major surgery.

Key Rules for Modifier 57

Major Surgeries Only: Use it only for procedures with a 90-day global period (such as an appendectomy or a major fracture repair).
Timing: The exam and the choice to operate must happen on the same day or the day before the surgery.
Where to Put It: Append it only to the E/M code (like an office or emergency room visit), not to the surgical procedure code.
Why It Matters: It unbundles the visit from the surgery package. This lets the doctor get paid separately for the initial evaluation.

When NOT to Use It

Do not use it for minor procedures that have a 0-day or 10-day global period.
Do not use it if the surgery was already planned or scheduled on a previous day.

What is a 24 modifier used for?

Modifier 24 is a medical billing code modifier appended to an Evaluation and Management (E/M) service to show that a visit is completely unrelated to a previous surgery.

Key Details on Usage

Global Period: Used during the 10-day or 90-day post-operative global period of a prior minor or major procedure.
Same Physician: Performed by the same physician or a qualified health care professional of the same group and specialty who performed the original surgery.
Different Diagnosis: Typically supported by a separate, distinct ICD-10 diagnosis code for a new condition (e.g., treating a rash or a completely different injury during recovery).

When NOT to Use It

Surgical Complications: Do not use it for routine post-operative care, wound treatments, suture removals, or infections related to the original surgery. These services are already bundled into the original surgical package.
Same-Day Visits: Do not use it for services rendered on the exact same day as the procedure.

Can 24 and 25 modifiers be billed together?

Yes, modifiers 24 and 25 can be reported together on the same claim, but only in specific, rare clinical scenarios.

You can apply both modifiers to the same Evaluation and Management (E/M) service code when a patient is in the global postoperative period of an earlier, unrelated surgery, and they return for a new, unrelated problem that requires both a significant E/M service and a separate minor procedure on that same day.

When You Can Use Them Together

Modifier 24 is attached to the E/M code to show that the visit happens during an active global surgical period, but the service is completely unrelated to the original surgery.
Modifier 25 is also attached to that same E/M code to show that the evaluation is significant, separately identifiable, and goes beyond the usual pre- or post-service work tied to the minor procedure performed on that same day.

Example Scenario

A patient is recovering from a recent knee surgery (currently in a 90-day global period with the same orthopedic surgeon). They return to the clinic complaining of an unrelated acute skin infection on their hand. The doctor evaluates the hand infection (warranting an E/M code with modifier 24 because it is during the knee surgery's post-op period, and modifier 25 because it is distinct from the minor procedure done today) and performs a minor incision and drainage of the hand abscess on the same day.

Billing and Sequencing Tips

Placement: Both modifiers 24 and 25 are applied directly to the single E/M code.
Sequencing: List Modifier 24 first before other modifiers to match standard primary postoperative computer edits.
Documentation: Ensure your clinical notes clearly defend why the visit is unrelated to the past surgery and why the E/M work is distinct from the minor procedure performed on the same date.

When should modifier 24 be used?

Modifier 24 should be used when a physician provides an unrelated evaluation and management (E/M) service to a patient during the global post-operative period of a previous procedure.

When to Use Modifier 24

New, unrelated problems: The patient visits for a totally different condition with a separate diagnosis code (ICD-10).
Underlying condition treatment: The visit treats the underlying condition that prompted the original surgery, rather than routine recovery.
Special therapy management: The surgeon manages ongoing chemotherapy or immunosuppressant therapy during a post-operative window.
Timing: The service happens on any day after the procedure, within the active 10-day or 90-day global period.

When NOT to Use Modifier 24

Surgical complications: Do not use it for treating infections, wound care, or removing sutures tied to the original surgery.
Same-day visits: Do not use it for services on the day of the procedure; use Modifier 25 instead.
Routine checks: Do not apply it to standard, expected post-operative follow-up visits.
Different specialties: Do not use it if the new visit is with a physician of a completely different specialty in a different group.