Modifiers · CPT modifier

Decision for surgery

Modifier 57 flags an evaluation and management visit as the encounter where the physician made the initial decision to proceed with a major procedure—one carrying a 90-day global period. Appending it prevents the E/M from being bundled into the surgical package, so the visit can be reimbursed separately. It applies whether the procedure is surgical or, in some cases, a major non-surgical intervention.

Verified May 8, 2026 · 8 sources ↓

Type: CPT
CPT codes use it: 443
Top regions: Other, Foot & ankle, Wrist

Drawn from AMACMSNovitas SolutionsAAPC

When to use modifier 57

Source · Editorial brief grounded in 8 cited references ↓

Append modifier 57 exclusively to the E/M procedure code when two conditions are both true: (1) the physician made the initial, documented decision to perform a major procedure during that visit, and (2) the procedure carries a 90-day global period under the Medicare Physician Fee Schedule Relative Value File. The visit must occur either on the same day as the surgery or on the calendar day immediately before it. A classic orthopedic scenario: a patient presents to the ED after a high-energy fall, imaging confirms a displaced femoral neck fracture, and the surgeon documents the decision to proceed with open reduction and internal fixation (ORIF) during that same encounter before wheeling the patient to the OR.

Modifier 57 is not a workaround for elective, pre-scheduled cases. If the surgical decision was made weeks earlier—say, at a prior office visit when the surgeon reviewed MRI findings and booked a total knee arthroplasty (TKA)—the pre-operative visit on the day before surgery is part of the 90-day global package and cannot be unbundled with modifier 57. The modifier exists specifically for situations where urgency or new clinical findings compel an immediate or next-day surgical decision that was not made at a prior encounter.

Payer rules largely mirror CMS guidance, but commercial carriers can vary. Some require the modifier only on the day of surgery; others honor the 'day before' allowance. Always verify whether the specific payer recognizes modifier 57 for non-surgical major procedures, because CMS does and many private payers do not. Document the decision-making process explicitly in the medical record—the note must make clear that this visit was the inflection point where surgery became the plan, not a routine pre-op check.

Orthopedic scenarios

Concrete situations in orthopedic practice that warrant modifier 57.

Source · Editorial brief grounded in AAOS coding guidance and cited references ↓

A patient arrives in the emergency department with an acute traumatic rotator cuff tear confirmed by MRI. The orthopedic surgeon evaluates the patient, documents the decision to perform arthroscopic rotator cuff repair that same afternoon, and appends modifier 57 to the E/M code billed for that encounter—allowing separate payment for both the visit and the arthroscopic procedure (CPT 29827).
An orthopaedist sees a patient in the office who reports sudden, severe knee locking. Examination and in-office imaging reveal a locked bucket-handle meniscal tear. The surgeon documents the decision to perform same-day arthroscopic partial meniscectomy (CPT 29881) and appends modifier 57 to the office visit E/M code to prevent it from being bundled into the 90-day global.
A patient with a closed femoral shaft fracture is evaluated in the ED the evening before a scheduled ORIF (CPT 27506). The trauma surgeon conducts a full E/M that evening, documents the operative decision, and submits the E/M with modifier 57 for the day-before visit, then submits the ORIF separately the following morning.
An orthopaedic surgeon evaluates a patient with a periprosthetic fracture around a total knee arthroplasty implant. During the consultation, the surgeon determines that revision TKA with fracture fixation is required and schedules the case for the next morning. Modifier 57 is appended to the consultation E/M to distinguish it from the 90-day global of the revision procedure (CPT 27447).
A spine surgeon sees a patient in the office reporting acute-onset myelopathic symptoms. MRI confirms severe central canal stenosis. The surgeon documents the emergent decision to perform a cervical laminectomy (CPT 63001) the following day. Modifier 57 on the office visit E/M allows that visit to be billed outside the surgical global period.

Common mistakes

Where coders most often go wrong with modifier 57.

Source · Editorial brief grounded in CMS NCCI Policy Manual and cited references ↓

Appending modifier 57 to the surgical CPT code instead of the E/M code—57 belongs only on the E/M, never on the procedure code.
Using modifier 57 for minor procedures with a 0-day or 10-day global period; those encounters require modifier 25, not 57.
Billing modifier 57 on a pre-op visit that occurs two or more days before surgery—the window is the day of or the day immediately before the procedure only.
Applying modifier 57 to a routine pre-operative E/M when the surgical decision was already made and the case was scheduled at a prior encounter; that visit is bundled into the global fee.
Confusing modifier 57 with modifier 25: modifier 25 applies to minor-procedure days, modifier 57 applies to major-procedure days with a 90-day global.
Failing to document in the medical record that this specific visit was the point of initial surgical decision—without that documentation, the modifier lacks medical necessity support and will be denied or recouped on audit.
Reporting modifier 57 when the surgery note states it is one stage of a planned multi-session procedure; staged procedures are explicitly excluded from separate E/M billing with modifier 57.

CPT codes that use modifier 57

443 orthopedic CPT codes in our reference list this modifier as applicable. Sorted by total RVU.

Source · Derived from per-code modifier guidance in our CPT reference

Showing top 12 of 443 by total RVU.

Where modifier 57 shows up

Body regions where this modifier most commonly appears in our orthopedic reference.

Other 72 codes
Foot & ankle 65 codes
Wrist 59 codes
Shoulder 50 codes

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Does modifier 57 apply to the surgical code or the E/M code?

It applies only to the E/M code. Appending modifier 57 to a surgical CPT code is incorrect and will typically result in a claim error or denial. The modifier signals to the payer that the E/M—not the surgery—is the service being unbundled from the global package.

02What makes a procedure 'major' for modifier 57 purposes?

CMS defines a major procedure as any procedure assigned a 90-day global period in the Medicare Physician Fee Schedule Relative Value File. Procedures with 0-day or 10-day global periods are considered minor, and modifier 57 cannot be used for them—use modifier 25 instead for those encounters.

03Can modifier 57 be used when surgery is scheduled two weeks after the decision visit?

No. Modifier 57 is valid only when the E/M occurs on the day of or the day immediately before the major procedure. A decision visit two weeks prior is not eligible; that E/M is a standard outpatient visit billed without the modifier and is not bundled into the surgical global.

04Is modifier 57 recognized by all payers, or just Medicare?

Medicare explicitly recognizes modifier 57 per the CMS Claims Processing Manual, Chapter 12. Most commercial payers follow CMS convention, but coverage policies vary—some commercial plans restrict it to surgical procedures only and do not honor it for major non-surgical procedures. Verify each payer's policy before submission.

05What documentation must the medical record contain to support modifier 57?

The note must clearly state that the decision to perform the specific major procedure was made during this encounter, describe the clinical findings or change in condition that prompted the decision, and distinguish the visit from a routine pre-operative evaluation. Vague language like 'patient to follow up for surgery' will not withstand audit scrutiny.

06Can modifier 57 and modifier 25 ever be used on the same claim?

They should not appear together on the same E/M line for the same service. Modifier 25 applies to minor-procedure days (0- or 10-day global); modifier 57 applies to major-procedure days (90-day global). If a claim has both on a single E/M code, it signals a coding error that will likely trigger a denial or audit.

07Does modifier 57 apply to non-surgical major procedures?

Yes, under CMS guidelines. If a non-surgical treatment carries a 90-day global period—such as certain closed fracture management codes like CPT 23505 for a clavicle fracture—modifier 57 can be appended to the E/M that generated the decision to pursue that treatment, provided the visit occurred on the day of or day before the procedure.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

01AMA CPT Professional Edition – Modifier 57 descriptor and guidelines
02CMS Medicare Claims Processing Manual, Publication 100-04, Chapter 12, Section 30.6.6.c
03CMS Medicare Claims Processing Manual, Publication 100-04, Chapter 12, Section 40
04CMS NCCI Medicare Policy Manual 2025, Chapter I – General Correct Coding Policies (https://www.cms.gov/files/document/01-chapter1-ncci-medicare-policy-manual-2025finalcleanpdf.pdf)
05CMS Global Surgery Fact Sheet (https://www.cms.gov/files/document/mln907166-global-surgery-booklet.pdf)
06Novitas Solutions Medicare JH – Modifier 57 Fact Sheet (https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144543)
07AAPC Knowledge Center – 'Modifier 57: For More Than Just Surgery' (https://www.aapc.com/blog/36675-modifier-57-is-for-more-than-surgery/)
08AAPC Orthopedic Coding Alert – 'Modifier -57 At a Glance' (https://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/modifier-57-at-a-glance-article)

Mira AI Scribe

Modifier 57 unlocks separate reimbursement for an E/M visit when that visit is the documented moment a surgeon decides a major procedure—one with a 90-day global period—is necessary. For AI scribes capturing orthopedic encounters: flag any note where the surgeon makes an initial operative decision on the same day or the day before surgery. Key documentation elements that support modifier 57 include: (1) a clear statement that the decision to operate was made during this encounter, (2) the clinical findings or change in condition that drove that decision, and (3) confirmation that surgery is not a continuation of a previously scheduled plan. Without those elements in the note, the modifier will not survive a payer audit. Do not auto-populate modifier 57 on every pre-operative visit—reserve it for genuine decision-point encounters.

See how Mira flags modifier 57 in dictation