Billing modifier · CMS claims manual
Modifier 57: the visit that led to the decision to operate.
Modifier 57 goes on the evaluation and management code for a visit that results in the initial decision to perform surgery. CMS allows it for major surgery on the day before or the day of the operation, so the visit is paid separately from the global surgery payment. It is not used with minor surgeries.
Modifier 57 at a glance
- Modifier
- 57: Decision for Surgery
- Used on
- E/M visit that results in the decision for major surgery (day before or day of)
- Medicare rule
- Paid separately from the global surgery payment; not used with minor surgeries
- Primary source
- CMS Ch. 12 s.40.2.A.4
What CMS says
CMS chapter 12, section 40.2.A.4: evaluation and management services on the day before major surgery or on the day of major surgery that result in the initial decision to perform the surgery are not included in the global surgery payment, and may be billed and paid separately. In addition to the CPT E/M code, modifier 57 identifies the visit.
If the E/M occurs on the day of surgery, the physician bills with modifier 57, not 25.
Why not minor procedures
CMS says modifier 57 is not used with minor surgeries because the global period for minor surgeries does not include the day before the surgery. Where the decision to perform a minor procedure is typically made immediately before the service, it is a routine preoperative service and no visit or consultation is billed in addition to the procedure. Section 40.1.C adds that the initial evaluation is always included in the allowance for a minor procedure.
Section 40.1.B also notes that the initial consultation to determine the need for surgery is outside the global package only for major surgical procedures.
How it differs from 25 and 24
Modifier 25 reports a significant, separately identifiable E/M on the day of a minor procedure or other service. Modifier 24 reports an unrelated E/M during the postoperative period. 57 is the one for the decision visit before or on the day of major surgery.
Look-alike modifiers
- Modifier 25: Significant, separate E/M on the day of a procedure.
- Modifier 54: Surgical care only.
- Modifier 58: Staged or related procedure.
The full modifier descriptions are in the AMA CPT code book and the HCPCS Level II code set; this page covers only what the CMS claims manuals say about modifier 57.
Sources
- CMS: Medicare Claims Processing Manual, Chapter 12 (Rev. 13753, issued 05-07-26) — sections 40.1 and 40.2.A.4, global package and decision for surgery (retrieved 2026-11-02)
Every rule above was read from these CMS pages on November 2, 2026. Payers revise policies and contracts, so confirm anything that affects a claim with the payer or your Medicare Administrative Contractor.
Frequently asked questions
When does CMS allow modifier 57?
On an E/M the day before or the day of major surgery that results in the initial decision to perform it.
Modifier 57 or 25 on the day of major surgery?
CMS says use 57, not 25, when the E/M that led to the decision occurs on the day of the major surgery.
Can I use modifier 57 with a minor procedure?
No. CMS says it is not used with minor surgeries, whose global period does not include the day before.
Not legal, billing or medical advice
This page explains published CMS manual text. It cannot see your claim, your contract or any payer’s policy. Confirm with the payer or your Medicare Administrative Contractor (MAC) before you bill, resubmit or appeal.