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Thread: Modifier 57

  1. #1

    Default Modifier 57

    AAPC: Back to School
    In some of my reserch of the 57 modifier, I have come across documentation which states that it is inappropriate to use the 57 modifier with new patient office visit codes (99201-99205). Is this true?

    I have looked in the Medicare guidelines for further explanation, however the documentation only states: "modifier 57 is used to identify a visit which results in the initial decision to perform surgery". The medicare guidelines don't expand upon the 57 modifier re: which visit codes it can and can't be used in. Any help/suggestions?

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    You may have run across someones opinion as I know of no rule, statute, or regulation that states you cannot use the 57 modifier on a new pt level. As far as I am aware it is applicable on any level when documentation supports.

    Debra A. Mitchell, MSPH, CPC-H

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