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PAP513

CPT Modifier 57


Provider Administrative Policy

Section
Physician
Policy Date
November 2007
Status/Date
Revised/January 2011
Provider Type(s)
Physician  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

CPT Modifier 57

Modifier '57' provides a means of identifying the evaluation and management (E/M) service that results in the initial decision to perform a major procedure. Blue Cross of Idaho defines a major procedure as a procedure having a 90-day global period. Report the E/M service that results in the initial decision to perform surgery by appending modifier '57' to the E/M service. Append modifier ‘57' to the E/M service only when planning a procedure with a 90-day global and making the decision for surgery.

Example: When the emergency room calls a physician to evaluate a patient with abdominal pain and the physician diagnoses appendicitis, submit the E/M service with a 57 modifier to identify the decision to perform surgery.


Policy History

Date Action Reason
January 2011 Revised Global period defined
March 2009 Revised Removed global period language
November 2008 Revised Language clarification
May 2008 Revised Title change

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