Three questions pick the right modifier: Is the E/M visit before, on the day of, or after a procedure? Is the procedure minor (0- or 10-day global) or major (90-day global)? Is the visit unrelated to that procedure? Modifier 24 covers an unrelated visit during the postoperative period. Modifier 25 covers a significant, separate visit on the day of a minor procedure. Modifier 57 covers the visit that leads to the decision for major surgery.
The three are easy to mix up because all of them attach to an E/M code and all of them exist to unbundle a visit from a global surgical package. This guide gives you the decision rules, worked examples, the documentation that holds up in an audit, and the mistakes that cause denials.
TL;DR
- Modifier 24: an unrelated E/M by the same physician or group during the postoperative period of a 10- or 90-day procedure. Never for complications or routine follow-up.
- Modifier 25: a significant, separately identifiable E/M on the same day as a minor procedure, above and beyond the usual pre- and post-procedure work.
- Modifier 57: the E/M that results in the initial decision for major (90-day) surgery, made the day of or the day before.
- Timing and global period decide most cases. Documentation decides whether the claim survives an audit.
- Same-physician rules apply. A different practice or specialty seeing the patient usually does not need these modifiers.
Table of Contents
- Why these three modifiers get confused
- Modifier 24: the unrelated visit after surgery
- Modifier 25: the separate visit on the day of a minor procedure
- Modifier 57: the visit that decides on major surgery
- Modifier 25 vs. 57: the same-day decision question
- Modifier 24 vs. 57
- Modifier 24 vs. 25
- A quick decision path
- Where practices lose money on these modifiers
- Our perspective: modifiers are a documentation problem first
- Find out what your modifier patterns are costing you
- Practical checklist for your billing team
- FAQ
- Sources
Why these three modifiers get confused
Medicare bundles a procedure's preoperative visits, the procedure itself and routine aftercare into one global package. The package length depends on the procedure: 0, 10 or 90 days. An E/M visit billed by the same physician inside that package is normally included in the surgical payment, so it needs a modifier to be paid separately.
The modifier you choose tells the payer why the visit is separate. That reason differs in each case:
| Modifier 24 | Modifier 25 | Modifier 57 | |
|---|---|---|---|
| When | After the procedure, during the global period | Same day as the procedure | Day of or day before the surgery |
| Procedure type | 10-day or 90-day global | Minor: 0-day or 10-day global | Major: 90-day global |
| What it says | The visit is unrelated to the surgery | The visit is significant and separate from the procedure's usual work | The visit produced the decision to operate |
| Typical trap | Using it for complications or suture removal | Using it for the decision to do a minor procedure | Using it for a visit more than a day before surgery |
The definitions above come from the Medicare NCCI Policy Manual, Chapter 8 (minor procedures and modifier 25), the Chapter 7 manual (major procedures and modifier 57) and an American Optometric Association billing guide (modifier 24).
Modifier 24: the unrelated visit after surgery
Modifier 24 reports an unrelated E/M service by the same physician or group during the postoperative period of a procedure. It applies inside a 10-day or 90-day global period, according to the AOA's modifier guidance.
It does not apply to services on the same day as the procedure. Those use 25 or 57. It also does not apply to anything related to the surgery.
What qualifies
- A patient two weeks out from a knee arthroplasty (90-day global) comes in for new-onset hypertension management by the surgeon's group.
- A patient in a 10-day global after a skin lesion excision presents with an unrelated acute respiratory illness.
What does not qualify
Per AAPC's coding alert on modifiers 24, 25 and 57, never use modifier 24 for a complication of the original procedure, for suture removal, or for follow-up care that is inherent to the surgical service. These are common triggers for payer denials.
How to document modifier 24
- State plainly that the problem is unrelated to the surgery.
- Link the diagnosis code to the visit that is truly separate, not to the surgical diagnosis.
- Record the date of the original procedure and where the patient sits in the global period.
- Show the history, assessment and plan for the new problem as its own work.
If the note reads like a routine wound check with a different diagnosis attached, expect a denial or a recoupment request.
Modifier 25: the separate visit on the day of a minor procedure
Modifier 25 reports a significant, separately identifiable E/M service on the same day as a minor procedure. Minor means a global period of 0 or 10 days under the Medicare Physician Fee Schedule. The E/M must describe work above and beyond the inherent pre- and post-procedure care of that procedure, per the NCCI Chapter 8 manual. The Novitas Modifier 25 fact sheet uses the same definition.
Two examples
- A patient comes in for a diabetes follow-up and, during the visit, you inject a trigger point or remove a skin tag for a separate complaint. The diabetes management is a separate E/M. Append 25 to the E/M.
- A patient arrives specifically for a planned wart destruction. The history and brief exam are part of the procedure. No separate E/M is billable.
The most common modifier 25 error
According to the AMA's guidance on reporting modifier 25, the typical mistake is using 25 to report the decision to perform a minor procedure. That decision is part of the procedure's global package. The E/M has to address a separate problem or go beyond the usual work.
Do you need two diagnosis codes?
Not as a rule. The NCCI manual points to the medical record: it has to show a significant, separately identifiable visit beyond the usual preoperative and postoperative work. Two different diagnosis codes help, but they do not replace a note that proves the point. Practices often run the E/M and the procedure note together in one block, which makes the separate work hard to defend in an audit.
A simple way to protect the claim: write the E/M as its own section with its own chief complaint, history, exam and assessment, and keep the procedure note (consent, site, technique, supplies) in a second section. Our guide to what auditors expect for modifier 25 documentation in 2026 goes deeper on this.
Modifier 57: the visit that decides on major surgery
Modifier 57 reports an E/M service that results in the initial decision to perform a major surgical procedure. Major means a 90-day global period. Under the NCCI Chapter 7 manual, the decision visit qualifies when it takes place on the day of or the day before the surgery.
A 90-day global normally includes the preoperative visits the day before and the day of surgery. Modifier 57 carves out the visit where the surgeon actually made the call, so it is paid separately.
Example: A patient is seen in the office on Tuesday for acute abdominal pain. After examination and imaging review, the surgeon decides to operate and schedules the surgery for Wednesday morning. Tuesday's E/M is reported with modifier 57.
Counter-example: A patient is seen three weeks before a planned hysterectomy and the decision is made then. The visit falls outside the day-before window, so the 57 rule does not fit this plan as written. Check how your payer treats a decision visit that early before you bill it.
Modifier 57 and your MAC
The 2026 NCCI manual notes that NCCI has no automated edits for modifier 57, because individual Medicare Administrative Contractors maintain their own. Your MAC's local coverage determinations and billing articles tell you how closely 57 is reviewed in your jurisdiction. Check them before building a billing rule around the modifier.
Modifier 25 vs. 57: the same-day decision question
This pair causes the most mistakes. Use the procedure's global period as the tiebreaker:
- Find the global period of the procedure you performed or scheduled (0, 10 or 90 days) in the Medicare Physician Fee Schedule.
- If it is 90 days (major): the E/M that led to the decision takes 57. A separate, unrelated problem addressed at the same visit is a different question and needs its own support.
- If it is 0 or 10 days (minor): the decision to do the procedure is part of the package. An E/M takes 25 only if it covers a significant, separate problem or work beyond the usual.
The AAPC's guide to modifiers 25 and 57 and its OB-GYN coding advice on untangling the two are useful companions. Both walk through the same split.
Modifier 24 vs. 57
The two sit at opposite ends of the surgical timeline. Modifier 57 is for the visit before surgery where the decision is made. Modifier 24 is for a visit after surgery for an unrelated problem. Because of that, they usually do not appear on the same visit.
The question that does arise in practice is a patient already in a postoperative period who needs a new major surgery for an unrelated problem. The decision visit for the second surgery falls inside the first global period. Payer policies differ on how to report that, so confirm your MAC's or the commercial payer's rule before billing.
Modifier 24 vs. 25
The difference is the date relative to the procedure:
- Same day as a minor procedure: 25.
- Later day within the global period of a procedure: 24.
They can both appear on one claim. The AAPC alert describes a patient in a 90-day global who returns for an unrelated E/M (24) and then needs an unrelated minor procedure that is also significant and separately identifiable (25). It is a legitimate combination, but it is technically complex to document and code, so it is often missed or done incorrectly.
A quick decision path
- Is the same physician or group billing both services? If a different physician in a different specialty and tax ID sees the patient, these global surgery modifiers generally do not apply, as the AAPC coding alert explains.
- Is the E/M on the same day as a procedure? Go to step 3. If it is on a later day, go to step 5. If it is the day before a major surgery, go to step 4.
- Same day: Minor procedure and a separate problem or significant extra work? Use 25. Major surgery and this visit made the decision? Use 57.
- Day before major surgery: Did this visit produce the decision to operate? Use 57. Otherwise it is part of the global package.
- Later day: Inside the 10- or 90-day period and unrelated to the surgery? Use 24. Related, a complication, or routine aftercare? Do not bill a separate E/M with 24.
AAPC also publishes a decision tree for modifiers 57 and 25 you can post at the coding desk.
Where practices lose money on these modifiers
The same few patterns show up in denials and audits:
- Missing modifiers. A real, separate visit goes out without 24, 25 or 57, and the payer bundles it into the procedure. The practice has earned the payment and never collects it.
- Reflexive modifier 25. Appending 25 to every E/M that shares a day with a procedure invites payer review, and a pattern of it can read like an overuse problem.
- Related visits billed with 24. A wound check, suture removal or complication billed as an unrelated E/M is a denial waiting to happen.
- Blended notes. The E/M and the procedure share one block of text, so an auditor cannot see separate work.
- Wrong global period assumed. Coders guess the 0-, 10- or 90-day status instead of checking the fee schedule.
- Payer-specific rules ignored. Commercial plans and MACs differ in edits and policy. Review them alongside the NCCI rules, covered in our NCCI edits 2026 overview and our piece on stopping batch Medicare denials.
Modifiers rarely fail in isolation. The surrounding rules matter too: modifier 59 misuse, time-based E/M selection and the broader 2026 guide to modifier usage in physician billing all affect whether a claim holds up.
Our perspective: modifiers are a documentation problem first
In an independent practice, the modifier is the last click of a long chain. A physician sees the patient, writes a note, a coder reads the note, and a charge goes out. By the time modifier 25 or 57 is chosen, the claim is already won or lost in the note.
We see three patterns behind most modifier trouble. First, the physician's note does not say why the visit was separate. Second, the coder sees a procedure and an E/M on one date and has to guess. Third, nobody looks at the claims the practice never submitted with a modifier but should have.
That third pattern is the quiet one. Denials are visible. Under-coding is not. A practice that is cautious after an audit scare may stop using 25 and 24 altogether and leave legitimate payments on the table. The fix is not more caution or more aggression. It is consistent documentation that makes the right modifier obvious, plus a review of E/M and procedure combinations by provider and payer.
That is how we built HIMShield to work: it scans EHR data before claims go out, flags where documentation does not support the modifier on the claim (or where a modifier is missing), and drafts physician-friendly corrections for one-click e-signature. Your physicians do not need to learn a new workflow to benefit.
— Elena
Find out what your modifier patterns are costing you
If you are not sure whether your E/M and procedure claims are under-coded, over-coded or just badly documented, a data review answers it faster than guesswork. Our free 30-day Revenue Leakage Audit quantifies coding, documentation and charge-capture gaps in your own EHR data, per provider and per payer. You can also see how our HIM compliance engagement fits an independent practice.
Practical checklist for your billing team
- Confirm the global period of every procedure code your practice bills, using the Medicare Physician Fee Schedule.
- Verify that the same physician or group is billing both the E/M and the procedure.
- Require the E/M and the procedure note to be separate sections in the chart.
- Build a short template phrase that states why the visit was separate, in the physician's words, not boilerplate.
- Review your MAC's and top commercial payers' policies for modifiers 24, 25 and 57 at least once a year.
- Audit a sample of claims quarterly: some with modifiers, some without, for the same procedure families.
Also watch for place-of-service and split/shared billing details when the visit happens in a facility. These are covered in our place of service code guide and our split/shared visit rules. For current-year changes, see the CMS 2026 action steps.
For a payer-specific view, a Medicare contractor's own page is a good starting point. Medicare's global surgery page for Florida lists billing guidance by modifier 24, 25 and 57, and the NGS Medicare modifier presentation covers when to use each.
FAQ
Can modifiers 24 and 57 be used together?
They describe different points on the surgical timeline, so they do not normally describe the same visit. Modifier 57 is for the decision visit on the day of or the day before major surgery, and 24 is for an unrelated visit after a procedure. If a patient in one global period needs a new major surgery, ask your payer how it wants the decision visit reported before you bill.
Can modifiers 24 and 25 go on the same claim?
Yes, on different lines for different services. For example, an unrelated E/M in a 90-day global gets 24, and a later, unrelated and significant E/M on the day of a minor procedure gets 25. Each service needs its own documentation.
Is modifier 25 needed if the patient only came in for the procedure?
No. When the visit is only for the planned procedure, the usual history, exam and decision are part of the procedure's package. Modifier 25 requires a significant, separately identifiable E/M that goes beyond that usual work.
Do these modifiers apply when another physician sees the patient?
Generally not. The global surgery rules apply to the same physician or group. If a different physician in a different specialty performs the E/M, modifiers 24, 25 and 57 are usually not needed. Check your payer's policy if the specialties overlap.
Sources
- Medicare NCCI Policy Manual 2026, Chapter 8
- Medicare NCCI Policy Manual 2026, Chapter 7
- AOA: Clearing up modifier confusion
- AMA: Reporting CPT modifier 25
- AAPC: Expert advice on modifier 24, 25 and 57 use
- Novitas Solutions: Modifier 25 fact sheet
- AAPC: Modifiers 25 and 57, a quick lesson
- AAPC: Untangle modifiers 25 and 57
- AAPC: Decision tree for modifiers 57 and 25
- NGS Medicare: When to use modifiers 24, 25 or 57
- First Coast Service Options: Global surgery