Modifiers: Modifier 57 Still Applies to Some Part B Claims, Despite Consult Pay Elimination

Why This Topic Matters

Understanding when modifier 57 still applies helps prevent avoidable bundling of E/M services into surgical procedures and supports correct reimbursement under Medicare Part B. The article is relevant for practices that bill hospital-based E/M services and procedures with global periods.

Article Sections

1. Background

   Introduces the Medicare policy change affecting consultation payment and explains the context for continued use of modifier 57.

2. Non-Consult E/M Codes Keep Modifier 57 Alive

   Discusses the role of modifier 57 in relation to non-consult E/M services and surgical decision-making, including hospital care scenarios and physician roles.

3. Differentiate Between Modifiers 25, 57

   Compares general use contexts for common E/M modifiers in relation to procedure timing and global periods.