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Like all other modifiers, you may only use -57 and -24 in certain situations. Which modifier you use will depend on whether a patient needs to have major surgery. This article will take a closer look at these modifiers and examine when and how you should use them before and after surgery. Modifier -57 You should append modifier -57 to an E/M service when the decision for major surgery is made during the visit. Major procedures have a 90-day global period, which means that no routine follow-up services can be billed in addition to the surgery for 90 days from the day of surgery.