Modifiers 24 and 57: Billing E/M Around the Global Surgery Period
The global surgery package bundles most visits before and after a procedure — but not all. Modifiers 24 and 57 unlock the E/M services you can still bill. Here is exactly when each applies and how they differ from 25.
The global surgery package is a bundle: the pre-op decision, the procedure, and routine post-op care are paid as one. The trap is that some visits around a surgery are still separately billable — and if you don't flag them with the right modifier, you give that revenue away. Modifiers 24 and 57 are how you keep it.
The global package, briefly
Major procedures carry a 90-day global period; minor ones carry 0 or 10 days. Within those windows, routine related E/M is bundled into the surgical payment. The modifiers exist to carve out the visits that aren't routine or aren't related. (For the full picture, see our global period modifiers reference.)
Modifier 57 — the decision for surgery
Append modifier 57 to the E/M service where you make the initial decision to perform major surgery (90-day global), on the day of or the day before the operation. That visit is not part of the global package and is separately payable. Important: 57 is for major surgery only — not minor procedures.
Modifier 24 — unrelated E/M after surgery
Use modifier 24 when the same physician provides an E/M during the postoperative period that is unrelated to the surgery — for example, treating a new, separate complaint while the patient is still in a knee-surgery global period. The unrelated nature is usually shown by a different diagnosis. Routine post-op follow-up stays bundled; unrelated care does not.
57 opens the door to surgery. 24 covers the unrelated visit after it. Neither is for routine, related care — that stays in the global package.
24 vs. 57 vs. 25
| Modifier | When | Which surgery |
|---|---|---|
| 57 | Decision for surgery (day of/before) | Major (90-day) |
| 24 | Unrelated E/M in post-op period | Any global |
| 25 | Separate E/M same day as minor procedure | Minor (0/10-day) |
Mixing these up — 57 on a minor procedure, or 25 on a major one — is one of the most common global-period coding errors, and exactly what disciplined medical coding prevents. See also our modifier 25 guide.
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The bottom line
The global package bundles routine care — but the decision-for-surgery visit (57) and unrelated post-op visits (24) remain billable. Match the modifier to the situation and the surgery's global length, and you keep revenue the bundle would otherwise swallow. Start with a free billing audit.
Sources
Frequently asked questions
Modifier 57 is appended to the E/M service at which the initial decision to perform major surgery (a 90-day global procedure) is made, on the day of or the day before surgery. It tells the payer this visit is not bundled into the global package.
Modifier 24 identifies an unrelated E/M service by the same physician during a procedure’s postoperative period. The visit must be unrelated to the surgery and is typically supported by a different diagnosis.
Modifier 57 is for the decision-for-surgery E/M before a major (90-day) procedure. Modifier 25 is for a significant, separately identifiable E/M on the same day as a minor procedure (0- or 10-day global). Using 57 on a minor procedure, or 25 on a major one, is a common error.
Generally yes — the postoperative E/M must be unrelated to the surgery, and a different diagnosis code supports that. Check your payer’s definition of "unrelated."
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