Medicare AdvantageBilling CodesMedium impact
MA03.010e, Modifier 57: Decision for Surgery
Independence Blue Cross·General Surgery, Orthopedics, Cardiothoracic Surgery +8 more·Coding
Effective date
Mar 5, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA03.010e regarding Modifier 57 (Decision for Surgery) has been reissued effective March 5, 2025. This policy governs when and how to apply modifier 57 for evaluation and management services that result in a decision for surgery performed the same day or next day.
Action Required
By March 5, 2025: Billing team must review updated MA03.010e policy for Modifier 57 usage requirements. Ensure billing staff understand current guidelines for applying modifier 57 to E&M services when surgery decision is made during the visit and surgery occurs same day or next day. Update billing system edits and staff training materials to reflect any policy changes.