Modifier 57
Decision for surgery — E/M service that resulted in the initial decision to perform the surgery
✅ When to Use Modifier 57
Only with E/M codes when the decision to perform a major surgery (90-day global) is made during that visit.
⛔ When NOT to Use Modifier 57
Do NOT use for minor procedures (0 or 10-day global). Use modifier 25 instead for minor procedures.
📋 Documentation Requirements
Document the clinical decision-making that led to the surgical recommendation.
Coding Tips for Modifier 57
Real-world specialist guidance from the PayerReady Medical Coding Team, including audit triggers, denial patterns, and payer policy variations.
Modifier 57 FAQ
What does modifier 57 mean? +
Decision for surgery — E/M service that resulted in the initial decision to perform the surgery
When should I use modifier 57? +
Only with E/M codes when the decision to perform a major surgery (90-day global) is made during that visit.
When should I NOT use modifier 57? +
Do NOT use for minor procedures (0 or 10-day global). Use modifier 25 instead for minor procedures.
What documentation is required for modifier 57? +
Document the clinical decision-making that led to the surgical recommendation.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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