Orthopedic Billing Services · 2026 Update

Modifiers 24, 25, and 57 in the 2026 Global Period

The cheat sheet auditors wish you had. Three modifiers, three completely different triggers, and one revenue leak that turns clean post-op E/M into a blanket denial.

Lead with the answer: Use Modifier 24 for an unrelated E/M during a post-op global period, Modifier 25 for a significant, separately identifiable E/M on the same day as a minor (000 or 010) procedure, and Modifier 57 for the E/M where you make the decision for a major (090) surgery, on the day of or the day before. Pick by trigger, not by habit, and the denial disappears.

MOD 24 · unrelated, in the global window MOD 25 · same-day, minor procedure MOD 57 · decision for major surgery

The side-by-side matrix

One table your denials team can pin to the wall

Read down the column for a single modifier, or read across a row to see how the three differ on the thing that actually matters: what triggers each one.

Compare by row

24Unrelated E/M, post-op

25Separate E/M, same day

57Decision for surgery

Trigger

A patient returns during an active global period for something unrelated to the original surgery.

A significant, separately identifiable E/M is done the same day as a minor procedure or injection.

The E/M visit is where the surgeon decides to operate on a major procedure.

Global period it lives in

Inside a 010 or 090 post-op window that is still running.

Same calendar day as a 000 or 010 minor procedure.

Attached to a 090 major procedure only.

Timing window

Day 1 through the last day of the post-op period.

Day 0 – the same date as the procedure.

Day of surgery or the day before (the 1-day pre-op window on 090 codes).

What it protects

A knee follow-up shouldn't bury the shoulder visit that has nothing to do with it.

The exam that led to the injection is real work, not bundled into the injection.

The consult that produced the surgical decision is not pre-op courtesy work.

Denial trap

Attached to a related follow-up. If it's the same body part and same problem, 24 is wrong.

Used as autopilot on every injection day. Payers audit 25 harder than any other modifier.

Swapped with 25 on a major procedure, or used when surgery was already scheduled earlier.

Rule of thumb: 57 belongs to 090 majors, 25 belongs to 000/010 minors, 24 belongs to the post-op window. If you can name the global-period designation of the procedure, the modifier chooses itself.

The 2026 global surgery clock

Where each modifier lives on the timeline

CMS assigns every surgical CPT a global-period indicator. Under the CY2026 Physician Fee Schedule global surgery policy, minor procedures carry 000 or 010-day periods and majors carry 090, each with a one-day pre-operative window built in.

DAY -1 to 0

Decision for surgery → MOD 57 (090 majors)

DAY 0

Same-day E/M + minor procedure → MOD 25

DAY 1 to 090

Unrelated visit in the window → MOD 24

Pre-op decision zone (57) Same-day separate E/M (25) Post-op window, unrelated (24)

What the 2026 rules actually say

The numbers that decide the modifier

000

Endoscopies and many injections. Same-day E/M needs Modifier 25.

CMS CY2026 PFS · global indicators

010

Minor procedures. 10-day post-op period; unrelated visits inside it take Modifier 24.

Medicare Claims Processing Manual, Ch.12 §30.6

090

Major orthopedic surgery. One pre-op day plus 90 post-op days. Decision-for-surgery E/M takes Modifier 57.

CMS CY2026 PFS · global surgery policy

1 day

The pre-operative window on 090 codes. This is why 57, not 25, applies to majors.

NCCI Policy Manual, Chapter 1

Pick in three questions

The 20-second decision, without the guesswork

Question 1

Is the E/M during an existing post-op period, for a different problem?

Same surgeon, active 010 or 090 window, unrelated complaint or body part.

→ Modifier 24

Question 2

Is it the same day as a minor (000/010) procedure, and clearly separate work?

The exam stands on its own beyond the procedure's inherent pre and post work.

→ Modifier 25

Question 3

Is this the visit where you decided to do the major (090) surgery?

Day of or day before. The E/M produced the surgical decision.

→ Modifier 57

What survives an audit

Documentation that holds each modifier up

A modifier is only as good as the note behind it. Auditors reverse the ones where the record doesn't show the trigger. Here is the minimum each one needs.

Modifier 24

A diagnosis distinct from the surgical problem
Note that ties the visit to the new complaint, not the recovery
Same physician or same-group, same specialty, within the global window
No routine post-op language ("healing well", "suture check")

Modifier 25

A standalone E/M with its own history, exam, and decision-making
Work above and beyond the procedure's inherent evaluation
Can share a diagnosis, but must be separately identifiable
Attached to a 000 or 010 minor code, never a 090 major

Modifier 57

The note states the decision to operate was made at this visit
Dated day-of or day-before the major (090) procedure
Surgery not already scheduled from an earlier encounter
Applied to the E/M line, not the surgical line

The 2026 site-of-service shift

Musculoskeletal cases are moving to the ASC

The CY2026 OPPS/ASC final rule continues adding musculoskeletal procedures to the ASC Covered Procedures List. As total joints and spine cases migrate out of the hospital, the surgeon's professional E/M and its modifier still ride on the physician claim. The global period follows the CPT code, not the building, so 24, 25, and 57 apply exactly the same way in the surgery center as they did in the outpatient department. The trap is assuming an ASC facility claim covers the professional decision-for-surgery visit. It does not.

Cited 2026 guidance

CMS Medicare Physician Fee Schedule (PFS) CY2026 Final Rule — global surgery policy and the 000 / 010 / 090 global-period indicators.
National Correct Coding Initiative (NCCI) Policy Manual, Chapter 1 — general correct-coding and modifier guidance, including the pre-operative window on major procedures.
Medicare Claims Processing Manual, Chapter 12, Section 30.6 — E/M services within the global surgical package.
CMS OPPS/ASC CY2026 Final Rule — ASC Covered Procedures List additions driving musculoskeletal migration to the surgery center.
AMA CPT 2026 — modifier definitions for 24, 25, and 57.

Your global-period modifiers should not cost you E/M revenue

When 24, 25, and 57 are applied by trigger instead of habit, post-op E/M stops disappearing into blanket denials. ASP-RCM Solutions builds this logic into orthopedic billing at the claim-scrub layer, so the right modifier is chosen before the claim ever leaves the building, and the appeals stack shrinks on its own.

Talk to our orthopedic billing team →

Educational summary of 2026 coding guidance for orthopedic billing operators. Verify every modifier against the current CMS Physician Fee Schedule, the NCCI Policy Manual, and your payer's medical policy before submission. Not coding, legal, or compliance advice.