Modifier 57- Decision for Surgery

Modifier 57 is used when an evaluation and management service results in the initial decision to perform a major surgery.

What is Modifier 57?

Modifier 57 tells insurance payers that the E/M service led directly to the decision for surgery and should be reported separately.

When to Use Modifier 57

• A provider determines surgery is necessary during the visit
• The surgery has a 90-day global period
• The E/M service goes beyond routine preoperative care
• Medical decision-making supports the surgical decision

Billing Example

A patient presents with severe abdominal pain and is evaluated by a surgeon. After assessment and testing, the provider decides emergency surgery is necessary. Modifier 57 may be appended to the E/M service.

Documentation Tips

• Clearly document the surgical decision
• Include medical necessity details
• Show that surgery was determined during the visit
• Avoid routine preoperative documentation only

Common Denial Reasons

• Surgery not classified as major
• Missing documentation supporting the decision
• Incorrect global period
• Routine preoperative evaluation billed separately

Related Modifiers

Modifier 25

Modifier 24

Modifier 79