Modifier 57

This modifier may be used to indicate that an evaluation and management (E/M) service performed on the same day or the day before a major surgery resulted in the decision to perform the procedure. This modifier should only be used for major surgeries which weren't planned in advance.

Correct use of Modifier 57

• Append where the decision to perform surgery is made the day of or day before a major surgery during an E/M service
• Append only to the E/M procedure code

Incorrect use of Modifier 57

• Appended to a surgical procedure code
• Appended to an E/M code when the surgery is minor (000 or 010 days)
• Don't report on the day of surgery if the surgical procedure indicates performance in multiple sessions or stages
• Don't append to critical care services

Clinical edit

We follow CMS guidance on the use of modifier 57. Claims with critical care codes billed with modifier 57 will deny indicating the service was billed without an appropriate modifier when reported on the same day of a minor surgery, or on the same day or the day before a major surgery. See the Modifier 25 separately identifiable same-day service page for appropriate modifier use.

Modifier 57 fact sheet (WPSGHA)