Modifier Code 57

Routine pre-operative and post-operative care associated with a major surgery is normally included in the global fee for the surgery and should not be billed separately. However, an evaluation and management (E/M) service performed on the day before or the day of a major surgery that resulted in the initial decision to perform the surgery may be billed separately and should be represented using modifier code 57.

Definitions

A major surgical procedure is considered by HMSA to be any procedure that has a 90-day post-operative period.

Guidelines for Use

HMSA recognizes modifier code 57 only under the following circumstances:

• The surgery being performed is a major surgery, and the initial determination to perform the surgery was made during the E/M visit.
• The E/M visit being separately billed is performed the day before or the day of the surgery.

Revision History