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Modifier 57

CPT numeric modifiers (AMA · CPT Appendix A)

Modifier 57. Decision for Surgery — E/M that led to the initial decision for a major (90-day global) surgery. Often confused with 25 (minor/same-day procedures).

This is a high-denial-risk modifier and a known OIG audit target — append it only when the documentation supports a distinct or separately identifiable service.

Reference only — CPT descriptors are AMA-copyrighted (paraphrased). Payment percentages and acceptance vary by payer; verify against the current CPT/HCPCS files and payer policy.

Related modifiers

22
Increased Procedural Services — work substantially greater than typical. Require…
23
Unusual Anesthesia — general anesthesia used where the procedure usually needs n…
24
Unrelated E/M During a Postoperative Period — same physician provides an E/M unr…
25
Significant, Separately Identifiable E/M on the Same Day as a Procedure — E/M ab…
26
Professional Component — bills only the physician's interpretation/supervision p…
27
Multiple Outpatient Hospital E/M Encounters on the Same Date — facility (hospita…
32
Mandated Services — service required by a third party (e.g., a payer-mandated se…
33
Preventive Services — flags an ACA-designated preventive service so commercial p…

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