Modifier 25 vs Modifier 57
Modifier 25 is for a separately identifiable E/M with a minor procedure. Modifier 57 is for the E/M that resulted in the decision to perform a major (90-day global) surgery.
Last reviewed May 24, 2026
Side by side
Modifier 25
Significant, separately identifiable E/M by the same physician on the same day as a procedure or service with a 0- or 10-day global.
Modifier 25- Used with minor procedures (0- or 10-day global).
- Documentation supports an E/M that exceeds the procedure's intrinsic work.
Modifier 57
Decision for surgery — the E/M that led directly to the decision to perform a major surgical procedure (90-day global) within the next 24 hours.
Modifier 57- Used with major procedures (90-day global).
- Applies the day of or the day before a major surgery.
- Without it, the E/M is bundled into the pre-operative period.
When to use Modifier 25
- A patient presents for a knee injection (10-day global) and is also seen for a new sinus complaint addressed at the same visit.
- An office E/M plus an in-office endometrial biopsy (0-day global) where the E/M was separate from the procedure work-up.
When to use Modifier 57
- An E/M visit in clinic where the surgeon evaluates the patient and decides that day to schedule surgery for the following morning.
- An emergency-department consult by the surgeon-on-call that results in same-day operative repair of a fracture (90-day global).
Common mistakes
- Using modifier 25 for a major-surgery decision — it does not unbundle the pre-op period; you need 57.
- Using modifier 57 with a minor (0/10-day) procedure — it does not apply; use 25 instead.
- Forgetting that the global period is set per CPT in the MPFS RVU file, not by procedure complexity.
Sources
- CMS — Global Surgery Booklet (MLN)https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/GloballSurgery-ICN907166.pdf
- CMS — MPFS Relative Value Fileshttps://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files
- AAPC — Modifier 57 explainedhttps://www.aapc.com/resources/medical-coding/modifiers.aspx
Related
Look up the global period in Ask D3
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This comparison is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at CMS, HHS, OCR, eCFR, NIST, and the relevant payer or state regulator. Last reviewed May 24, 2026.