When should modifier 57 be added to an E/M Code?

re: When should modifier 57 be added to an E/M Code?

Modifier 57 identifies an E/M service that reslted in the intial decisoin to perform surgery. The CPT® book does not designate whether the surgery decided upon is major or minor, diagnosisitc or therapeutic, use modifer 57 to identify when the decision for any surgery is made.

re: When should modifier 57 be added to an E/M Code?

57 Decision for Surgery: An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service.

Modifier 57 identifies an E/M service that resulted in the initial decision to perform surgery. Because the CPT® book does not designate whether the surgery decided upon is major or minor, diagnostic or therapeutic, use modifier 57 to identify when the decision for any surgery is made.


The prevailing industry standard is to use modifier 25 for minor procedures and modifier 57 on major procedures. CMS identifies minor as having 10 or less follow-up days and major as having 90 follow-up days assigned. Providers are more likely to use modifier 25 to identify that a significant, separately reportable E/M service was provided on the same day a minor procedure was performed.

Below is a link to CMS document stating that they follow the above statement

www.cms.gov/Outreach-and.../GloballSurgery-ICN907166.pdf