E/MMedium audit riskCPT

CPT Modifier 57

Decision for Surgery

Source: AMA CPT / CMS HCPCS Level II definitions. Maintained by the D3rx Clinical Billing Team.

What modifier 57 means

Modifier 57 is appended to an E/M service that resulted in the initial decision to perform a major surgery (one with a 90-day global period), when that E/M occurs the day of or the day before the procedure. It allows the decision-making E/M to be paid separately rather than being bundled into the global surgical package.

When to use it

An E/M visit at which the decision to perform a major (90-day global) surgery is made, on the day before or the day of the operation.

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Documentation checklist

The record should support every item below before you append modifier 57.

  • That this encounter was the decision-making visit for the major surgery
  • That the procedure carries a 90-day global period
  • The date relationship between the E/M and the surgery (day of or day before)

Do NOT use modifier 57 when

  • The procedure is minor (000/010 global) — use modifier 25
  • The decision for surgery was made at an earlier visit outside the day-before window
  • It is routine preoperative clearance

Common denial reasons

  • Used on a minor-procedure E/M (should be 25)
  • The decision for surgery was not actually made at this visit
  • Payer bundles the E/M into the global package

Denial codes you may see with modifier 57

CO-97CO-4CO-50

How to appeal a modifier 57 denial

Show that the E/M occurred the day of or day before a 90-day-global procedure and that the surgical decision was made at this encounter. Distinguish it from routine pre-op and confirm the procedure's global indicator is 90 days.

Payer notes

Modifier 57 applies to major (90-day) procedures; for minor procedures the correct modifier is 25. Medicare keys on the day-of / day-before timing as the distinguishing factor.

Related & commonly confused modifiers

Modifier 25Modifier 24Modifier 58

Where modifier 57 is used

  • E/M immediately preceding major surgery (99202–99215, hospital E/M)

Look up these codes & their 2026 Medicare rates

9920299215

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Medical billing disclaimer

Modifier definitions follow standard AMA CPT and CMS HCPCS Level II guidance and are for educational reference. Payer policies, billing formats, and coverage rules vary and change. Always verify the current rule with the specific payer before submitting. D3rx is not responsible for claim outcomes.