Glossary
Modifier 57
Short answer
Modifier 57 is added to an evaluation and management (E/M) code for the visit, on the day before or the day of a major surgery, that led to the initial decision to operate, so that visit is paid outside the global surgical package.
Browse more terms in the medical billing glossary.
Last reviewed by the Remitwright billing team. Editorial policy
Also written as57 modifier
A major procedure, one with a 90-day global period, includes the preoperative visits from the day before surgery. Left alone, that rule would swallow the visit where the surgeon first examined the patient and concluded an operation was needed, so CMS carves that visit out. Billed with modifier 57, the E/M service that produced the initial decision to operate is paid separately even when it happens the day before or the day of the operation. On the day of a major surgery, that visit carries 57, not 25.
The modifier works only for major surgery. CMS says not to use 57 with minor procedures, because their global period does not reach back to the day before, and a decision made just before a minor procedure is treated as routine preoperative work that is not billed on top of the procedure. Contractors do not pay an E/M billed with 57 on the day of, or the day before, a procedure with a 0-day or 10-day global period. For those procedures, a separate visit on the procedure day is a modifier 25 question instead.
The mistake runs both ways. Adding 57 to every preoperative visit, including a history and physical scheduled after the decision was already made, bills for work the global package already pays. Leaving it off a same-day consult that led straight to surgery loses the visit to the global package or a bundling denial. The note should show that the decision to operate was made at this encounter, and the visit date should fall on the day before or the day of the surgery.
Modifier 57 in practice
A general surgeon sees a patient in the emergency department, diagnoses appendicitis and decides to operate that evening. The consult is billed with modifier 57, and the appendectomy is billed under its own global surgery rules. Hypothetical example.
Next step
Talk to a biller about this.
Three quick questions, no patient data. A billing specialist reads every request and replies in writing.
- Three questions, about two minutes
- No patient data, no software to buy
- A written reply from a biller, not a sales deck
You answer three questions
A billing specialist reads them
A written reply by email
Prefer email? sales@remitwright.com
Request received
Thanks. Your review request is in.
Reference . Quote it if you write to us about this request.
- A billing specialist reads your answers and replies by email.
- If a look at real claims makes sense, we agree read-only access under a BAA first.
- You get a written summary of what is worth working and what it would take. No commitment.
While you wait: see the sample weekly report or read how switching works. You can also download the sample weekly report (PDF).