Modifier -57 Gains Payment for Preoperative Exams

Why This Topic Matters

Understanding this topic helps avoid unintentional bundling of preoperative visits and supports more accurate claims submission and appeals. It is especially relevant for practices that bill surgical and evaluation services across Medicare and non-Medicare payers.

Article Sections

1. Global Services Versus Decision for Surgery

   Explains the relationship between global surgical packages and preoperative evaluation and management services. It also introduces the Medicare framework for when a visit is considered part of routine global care versus a decision-related service.

2. Pay Attention to Global Periods

   Discusses how global periods affect reporting of surgical and evaluation services across different procedure types. It also covers the distinction between major and minor procedures and how payer interpretation may vary.

3. Third-Party Payer Rules Differ

   Describes how non-Medicare insurers may handle global surgery and same-day evaluation and management services differently. It highlights the importance of payer-specific policies, written guidance, and appeal preparation.