Modifier 57: Decision for Surgery

What Is Modifier 57?

Modifier 57 (decision for surgery) goes on an E/M visit when that visit is where the provider decided to operate. Without it, Medicare treats a visit on the day of or the day before a major surgery as part of the surgery's global payment, so the visit is not paid on its own.

Medicare's Rule, in CMS's Words

The Medicare Claims Processing Manual (Chapter 12, Section 30.6.6) says contractors pay for an E/M service "on the day of or on the day before a procedure with a 90-day global surgical period if the physician uses CPT modifier -57 to indicate that the service resulted in the decision to perform the procedure." It also says they may not pay a visit with modifier 57 before a procedure with a 0 or 10-day global period.

The 2026 NCCI Policy Manual (Chapter 1) agrees. A procedure with a 90-day global period is a major surgical procedure, and an E/M on the same date "to decide whether to perform this surgical procedure" is reportable with modifier 57. Other visits before major surgery on that date are included in the global payment.

Modifier 57 vs 25 vs 24

For minor procedures, Medicare treats the decision to do the procedure as part of the procedure. That is why 57 does not apply to them, and why you need a truly separate problem or extra work to use 25.

How to Check the Global Period

Every surgical code has a global period in the CMS fee schedule: 000, 010 or 090. Look up any code in our global period calculator. A few common examples from the 2026 file:

Examples

Emergency department decision. A surgeon sees a patient in the emergency department for belly pain, diagnoses appendicitis and operates that evening (44970, 90-day global). Bill the surgeon's emergency department visit with modifier 57.

Decision during observation. CMS gives this example: an emergency physician places a patient with a head injury in observation, and a neurosurgeon is called in and decides the patient needs surgery. The neurosurgeon bills an office or outpatient visit code with modifier 57.

Pre-op visit after the decision. A surgeon decided on a knee replacement two weeks ago and sees the patient the day before surgery to review consent. The decision was made earlier, so this visit is part of the global payment. No modifier 57.

Minor procedure. A patient comes in for knee pain and gets a joint injection (20610, 0-day global) at the same visit. Modifier 57 does not apply. Use 25 only if the visit included significant, separate work beyond the usual check before an injection.

Documentation That Supports 57

• State the decision in the note, for example: "Discussed findings, risks and options. Patient agrees to proceed with laparoscopic cholecystectomy."
• Make sure the visit date is the day of or the day before the surgery.
• Put modifier 57 on the E/M line, not on the surgery line.
• Check the surgery code's global period is 90 days before you use 57 for Medicare.

Common Modifier 57 Denials

• Visit bundled into the surgery. Usually CO-97 or a global surgery edit, because 57 was left off. Add it if the documentation supports it, and resubmit.
• 57 on a minor procedure. Medicare will not pay it. Rebill with 25 only if the visit was truly separate.
• 57 on the wrong line. It belongs on the E/M code.
• Commercial payer rules. CPT's own definition does not limit 57 to 90-day procedures, and some commercial payers allow it more widely. Others follow Medicare. Check the payer's policy before you appeal.

Sources: Medicare Claims Processing Manual, Chapter 12, Sections 30.6.6 and 40; CMS NCCI Policy Manual for Medicare Services, 2026, Chapter 1; CMS 2026 Medicare Physician Fee Schedule global surgery indicators.

Frequently Asked Questions