Modifier 57: Decision for Surgery
Modifier 57 gets the visit that leads to a major surgery paid when it falls the day before or day of the operation. Medicare rules, 57 vs 25, and denial traps.
Modifier 57 is a billing modifier that goes on an evaluation and management (E/M) visit when that visit is where the surgeon first decides to perform a major surgery, and it happens the day before or the day of the operation. Medicare otherwise folds visits on those two days into the surgery's global package; with 57, the decision visit is paid separately at its full rate.
Key takeaways
- 57 is only for major surgery: procedures with a 90-day global period.
- It only matters on the day before or the day of surgery. Earlier visits are outside the global package and need no modifier.
- On the day of a major surgery, a decision visit takes 57, not 25.
- For minor procedures (0 or 10 global days) the decision to operate is part of the procedure; a separate visit needs a significant, separately identifiable problem and modifier 25.
- 57 doesn't change the visit's rate. It only stops the bundling denial.
Modifier 57 · payment effect
With and without the modifier
99204 without 57 · national office
$177.36
Office visit
99204-57 · No change to the rate
$177.36
Lets the visit where major surgery was decided be paid at its full rate instead of being bundled.
When to use modifier 57
Medicare's global package for a major surgery starts with the day before the operation (Pub. 100-04, ch. 12, §40.1.A). Any visit by the surgeon on that day or the day of surgery is presumed to be routine preoperative care. The exception is the visit that produces the initial decision to operate. CMS says those visits are not included in the global payment and may be billed separately with 57 (§40.2.A.4).
Use 57 when all of these are true:
- The surgery has a 090 global indicator. Check it on the code page or with the global period calculator.
- The visit is on the day before or the day of the surgery.
- The visit is where the surgeon first decided surgery was needed, and the note says so.
- The surgeon, or a partner in the same group and specialty, will perform the procedure.
Example. A patient comes to the emergency department on March 1, 2026 with a displaced hip fracture. The orthopedic surgeon evaluates her, decides she needs surgery, and operates on March 2. The surgeon's March 1 hospital visit (for example, initial hospital care, 99223) is billed with 57; the surgery is billed normally.
Global surgery period · 27447
Total knee replacement
90-day global period ends
May 31, 2026
Covers Mar 1, 2026 through May 31, 2026 (92 days, including the day before surgery).
Visit on Apr 1, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
When not to use modifier 57
- Minor procedures and endoscopies (000 or 010 global days). CMS says 57 is not used with minor surgeries, and MACs may not pay a 57 visit on the day of or day before such a procedure (MLN907166). If the patient had a significant, separately identifiable problem, use modifier 25.
- Visits two or more days before a major surgery. They fall outside the global package and are billed without a global modifier.
- Visits after surgery. Unrelated postoperative visits take 24; related follow-up is included.
How modifier 57 affects payment
Modifier 57 has no payment percentage. The E/M visit is paid at its full fee schedule amount (§40.4.A lists 57 among modifiers that allow separate payment), and the surgery is paid as usual. Without 57, the visit is denied as part of the global package. The modifier goes on the E/M code only, never on the procedure.
Modifier 57 vs 25 and 24
| Modifier | Goes on | Use it when | Payment effect |
|---|---|---|---|
| 57 | E/M visit | The visit decides on a major (90-day) surgery the day before or day of | None; visit paid in full |
| 25 | E/M visit | A significant, separate problem is handled on the day of a minor procedure or other service | None; visit paid in full |
| 24 | E/M visit | An unrelated visit falls in a surgery's postoperative period | None; visit paid in full |
| 58 | Procedure | A planned or more extensive procedure follows an earlier surgery | None; new global period |
The deciding fact is the global days of the procedure: 090 means 57; 000 or 010 means 25. The modifier 25 vs 59 guide covers the other common same-day choice.
FAQ
What is modifier 57 used for?
It marks the visit at which the surgeon decided to perform a major surgery, when that visit falls on the day before or day of the operation. It keeps Medicare from bundling the visit into the surgery's global payment.
What is the difference between modifier 25 and 57?
Both go on E/M visits. 57 is for the visit that decides on a major surgery (90 global days) on the day before or day of. 25 is for a significant, separately identifiable visit on the same day as a minor procedure or other service. CMS says a decision visit on the day of a major surgery takes 57, not 25.
What is the difference between modifiers 24 and 57?
24 is for a visit during a surgery's postoperative period for a problem unrelated to that surgery. 57 is for the visit just before a new major surgery where the decision to operate was made.
Can modifiers 57 and 24 be billed together?
They can both apply to one visit: a patient in the postoperative period of one surgery is seen by the same surgeon for a new, unrelated problem, and that visit leads to a new major surgery the next day. The visit is unrelated to the first surgery (24) and is the decision visit for the second (57).
Can modifier 57 be used for minor surgery?
No. Medicare's global package for a minor procedure starts on the day of the procedure, and deciding to do it is part of the service. A separate problem treated that day takes modifier 25.
Keep reading
- Modifier 25 for visits on the day of minor procedures.
- Modifier 24, 58, 78 and 79 for the rest of the global period.
- Global period calculator to see where the preoperative day falls.
- Codes on this page: 99204 99223 27447
Sources: CMS Medicare Claims Processing Manual, Pub. 100-04, ch. 12, §§40.1, 40.2.A.4 and 40.4.A; CMS MLN907166, Global Surgery (December 2025). Verified October 6, 2026.
