Is modifier 57 only for major surgery?
Asked by: Kylee Ziemann | Last update: October 8, 2025Score: 4.4/5 (72 votes)
When should a 57 modifier be used?
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. Modifier 57 should only be appended to E/M codes.
What is the modifier for surgery only?
SURGICAL CARE ONLY: WHEN ONE PHYSICIAN PERFORMS A SURGICAL PROCEDURE AND ANOTHER PROVIDES PREOPERATIVE AND/OR POSTOPERATIVE MANAGEMENT, SURGICAL SERVICES MAY BE IDENTIFIED BY ADDING THE MODIFIER -54 TO THE USUAL PROCEDURE NUMBER OR BY USE OF THE SEPARATE FIVE DIGIT MODIFIER CODE 09954.
What modifier do you use for decision for surgery?
Modifier -57: Used to indicate that a particular Evaluation and Management (E&M) service performed in the pre-operative period of a major surgical procedure resulted in a decision to perform that surgical service.
What is the difference between modifier 25 and 57?
Modifier 25's instructions specifically indicate that it is not to be used to report an E/M service that resulted in a decision to perform surgery. In such instances, modifier 57, Decision for Surgery, should be appended to the E/M services code.
Modifier 57 Decision for Surgery explained medical coding
Does Medicare recognize modifier 57?
Revision Date (Medicare): 1/1/2022
If an E&M service is performed on the same date of service as a major surgical procedure for the purpose of deciding whether to perform this surgical procedure, the E&M service is separately reportable with modifier 57.
What is modifier 25 not used for?
Modifier 25 should not be used when: ❌ The sole purpose of the encounter is for the procedure (e.g., lesion removal), and there is no documented medical necessity for a separate E/M service.
Can you use modifier 24 and 57 together?
Modifier 57 is used to indicate that an E/M service resulted in the decision for surgery, while modifier 24 is used for unrelated E/M services during the postoperative period. These modifiers address different situations and should not be used simultaneously.
What are the major surgeries?
Major surgery – such as surgery to the organs of the head, chest and abdomen. Examples of major surgery include organ transplant, removal of a brain tumour, removal of a damaged kidney or open-heart surgery.
What modifier would be used for second surgical opinion?
Modifier 51 is appropriate to indicate a second and third subsequent different procedures.
What is the modifier for surgery within 24 hours?
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.
Can you bill for a preoperative visit?
Preoperative examinations may be billed by using an appropriate CPT code (e.g., new patient, established patient, or consultation). Preoperative Diagnostic Tests. –Tests performed to determine a patient's perioperative risk and optimize perioperative care.
What is the one modifier that is not used with anesthesia procedures?
There are instances where multiple procedures are performed but modifier 51 is not appropriate. Modifier 51 is not appended to add-on codes.
What is the 57 modifier for NCCI?
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 or the day of a major surgery (90-day global).
How do you know when to use a modifier?
- The service or procedure has both professional and technical components.
- More than one provider performed the service or procedure.
- More than one location was involved.
What is included in the surgical package?
1. What is included in CPT's surgical package? The global surgical package concept includes the preoperative, intraoperative and postoperative services, and are considered included in the specific CPT code.
What are the four major categories of surgery?
- Diagnostic Surgery.
- Preventive Surgery.
- Surgery for Primary Treatment.
- Palliative Surgery.
What are the top 3 riskiest surgeries?
- Brain surgery. One of the most dangerous procedures is any type of surgery on the brain or skull. ...
- Heart surgery. ...
- Cancer surgery. ...
- Transplants. ...
- Spinal cord surgery. ...
- What if my doctor made a mistake during my surgery?
What is the mother of all surgeries?
Treating pseudomyxoma peritonei and some appendix cancers can be challenging. The surgical procedure is commonly referred to as MOAS (Mother of All Surgeries) because, depending on the extent of cancerous tissue and affected organs that need to be removed, it can be comparable to undergoing several major surgeries.
When should modifier 57 be used?
Modifier -57 is appended to office visits the same day or within three days of a major surgery (90-day global period). It indicates the office visit includes the decision for the major procedure.
What is the difference between modifier 57 and 59?
The Modifier 57 is appended to the E/M visit to indicate that service resulted in the decision to go to surgery. Modifier 59 should be used to report procedures or services that are not normally reported together but are appropriate under the circumstances.
What modifier do you use for same day surgery?
CPT defines modifier 25 as “Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service.” It may be necessary to indicate that, on the day a procedure or service identified by a CPT code is ...
Can you bill both modifier 25 and 57 together?
Both Major and Minor Surgeries on the Same Day When a decision for surgery includes both major and minor surgeries and is made the day of surgery, the E&M billed for the decision must have both modifier –57 and modifier –25 appended.
When to use modifier 24?
- This modifier may be used to indicate that an evaluation and management (E/M) service or eye exam, which falls within the global period of a major or minor surgery and which is performed by the surgeon, is unrelated to the surgery. ...
- This modifier may only be submitted with E/M and eye exam codes.
What is modifier 59 used for?
For the NCCI, the primary purpose of CPT® modifier 59 is to indicate that two or more procedures are performed at different anatomic sites or during different patient encounters. It should only be used if no other modifier more appropriately describes the relationships of the two or more procedure codes.