Are you concerned about new changes to the global surgery period? With the Office of Inspector General (OIG) focusing on postoperative services, understanding the 2025 updates is more important than ever.
This guide from RxCredentialing walks you through the new coding requirements, key modifiers, and how to stay compliant with Medicare regulations.
What Is a Global Surgery Package?
A Global Surgery Package (also known as the global period) is a Medicare concept where a single payment for a surgical procedure covers the surgery itself and all related services provided before, during, and after the procedure. This payment bundle covers preoperative visits, the surgery, and postoperative care (like follow-up visits) within a specific time frame, typically 0, 10, or 90 days.
When providers in the same group and specialty are involved in the surgical procedure, they must submit their claims and accept payment as a single provider. This simplifies billing and prevents double charges for the same services.
Global Surgery Package Duration and Procedure Types
The length of the global period depends on the type of procedure performed, as defined by Medicare.
| Global Surgery Period | Type of Procedure | Examples of Procedures |
|---|---|---|
| 0-day | Procedures with no postoperative care | Diagnostic procedures, certain minor surgeries |
| 10-day | Minor procedures with a short recovery | Laceration repair, certain endoscopic procedures |
| 90-day | Major surgeries requiring extended care | Orthopedic surgeries (e.g., fracture repair), abdominal surgeries, some cardiovascular procedures |
CMS Guidelines: What Is Included in the Global Surgery Package?
For Medicare claims, the following services are included in the global surgery payment and cannot be billed separately.
These are visits that happen after the decision to operate has been made. For minor surgeries or endoscopies, this includes the evaluation and management (E/M) visit on the same day as the procedure.
These are all services provided during the actual surgery, including everything necessary to perform the procedure.
These are routine check-ups or follow-up appointments to monitor the patient’s recovery during the global period. The code 99024 is often used to track these visits, but it is not separately reimbursable.
This includes care provided by the surgeon to help the patient manage pain after the surgery, such as medication or therapy.
Materials used during the surgery and routine tasks related to recovery, like bandage changes, incision care, and the removal of stitches or staples.
CMS Guidelines: What Isn’t Included in the Global Surgical Package?
Here are services that CMS does not include in the global package. These can be billed separately and may require specific modifiers.
The surgeon’s initial evaluation visit (E/M) to determine if a major surgery is needed is not part of the global package and can be billed separately using modifier 57.
Services provided by other providers (not the surgeon) are excluded unless a formal transfer of care is documented. These services, such as postoperative care, can be billed separately. For help managing these scenarios, consider our physician billing services.
Follow-up visits for conditions unrelated to the surgery or its diagnosis, or treatments for separate health conditions, are not included in the global package. They can be billed separately using the correct modifiers, such as modifier 24 or 79.
Surgeries that are not part of the original procedure or a planned stage can be billed separately. If a patient returns to the operating room for a related complication, the procedure can be billed separately using modifier 78.
Critical care provided after surgery for issues unrelated to the surgical procedure can be billed separately. These services should be billed separately using modifier FT.
Key 2025 Global Surgery Updates
The 2025 updates bring several key changes, including a new focus from the OIG and the introduction of a new HCPCS code.
- HCPCS Code G0559: This new code is used for postoperative follow-up visits provided by a different healthcare professional who didn’t perform the surgery, within the 90-day global period, and without a formal transfer of care.
- Stricter Modifier Use: Modifiers 54, 55, and 56 are now more strictly required for managing split care, with modifier 56 specifically requiring formal documentation for preoperative care transfers.
- OIG Review of Postoperative Services: The Office of Inspector General (OIG) is actively reviewing postoperative services to ensure proper reporting and prevent over-reporting during the global period, which could lead to devaluation of the global surgery payment.
The Role of the OIG and CMS in Global Surgery Coding
The OIG is investigating how well postoperative services are reported under Medicare’s global surgery payment system. Since 2017, Medicare has required providers to report postoperative visits using CPT code 99024. While these visits are part of the global period and are not paid separately, reporting them helps Medicare track the need for follow-ups and ensures the global payment is accurate.
The OIG will review a sample of global surgeries and compare the reported follow-up visits with the actual care provided. If providers don’t report this information properly, it could lead to Medicare paying less for those surgeries in the future.
This tracking is primarily required for practitioners in specific states (like Florida, Kentucky, and Ohio) and applies to certain surgeries selected by Medicare because they are either very common or very expensive.
Importance of Using Modifiers During the Global Period
Using the correct global surgery modifiers is essential to get paid for services that aren't included in the global package. These modifiers tell Medicare that a service is separate and billable, even if it falls within the global period.
| Modifier | Description | When to Use |
|---|---|---|
| 24 | Unrelated evaluation and management (E/M) service | During the postoperative period for unrelated care. |
| 25 | Significant, separately identifiable E/M service | On the same day as a procedure. |
| 54 | Surgical care only | When only the surgery is provided, and a different provider handles pre- and post-op care. |
| 55 | Postoperative care only | When a different provider manages postoperative care after a formal transfer of care. |
| 56 | Preoperative care only | When a different provider manages pre-operative care without involvement in the surgery or post-op care. |
| 58 | Staged or related procedure | For a planned, related follow-up procedure during the global period. |
| 78 | Unplanned return to the OR | For related complications requiring further surgery after the original surgery. |
| 79 | Unrelated procedure or service | For a new, unrelated surgery during the global period. |
| FT | Unrelated E/M service during global period | For an unrelated E/M service on the same day as a procedure, such as critical care. |
Common Modifier Examples
Example: A patient has knee surgery with a 90-day global period. Five days later, they return to the same surgeon with new back pain unrelated to the surgery. The surgeon performs an E/M service to diagnose and treat the back pain. The E/M code for this visit would be billed with modifier 24 to show it is a separate, unrelated service.
Example: A patient is scheduled for a minor procedure. On the same day, before the procedure, the doctor performs a significant E/M service to evaluate a new, acute issue, like high blood pressure. This E/M service goes beyond the standard pre-operative check. The E/M code is billed with modifier 25 to show it's separate from the procedure.
These modifiers are used when two or more physicians in the same group practice split the pre-operative, surgical, and post-operative responsibilities. For instance, an emergency department physician might perform a reduction for a dislocated shoulder and use modifier 54 for the surgical care. The patient is then referred to an orthopedic specialist for follow-up care, who would use modifier 55. For help navigating complex billing scenarios with these modifiers, consider our insurance credentialing service.
Example: A patient has surgery and is discharged. During the global period, they return to the operating room due to a complication from the first surgery, such as internal bleeding. The surgeon performs a procedure to stop the bleeding. This new procedure code would be billed with modifier 78. This modifier signals that it's a complication of the original surgery, and does not start a new global period.
Best Practices for Global Surgery Coding Compliance
Staying compliant with new regulations can be complex. Here are some key best practices to follow to avoid denials and ensure accurate reimbursement. If you are struggling with a high number of denials, consider our healthcare denial management services.
- Proper Documentation: Keep complete and accurate documentation for all care services, including clear records for any transfer of care.
- Know the Global Period: Understand the specific global period (0, 10, or 90 days) for each procedure you perform.
- Use the Correct Modifiers: Use the appropriate modifiers (24, 25, 54, 55, 56, 58, 78, 79, FT) when services are provided outside the scope of the global package.
- Apply G0559 Correctly: Use the new HCPCS code G0559 for post-operative follow-up visits provided by an outside provider during a 90-day global period without a formal transfer of care.
- Stay Updated: Regularly review updates from CMS and the OIG to stay compliant with new coding guidelines.
Frequently Asked Questions
No, global surgery applies to all settings, such as hospitals (inpatient and outpatient), ambulatory surgical centers (ASCs), and doctors’ offices. Surgeon visits to Medicare patients in intensive or critical care units are also included in the global surgical package.
Medicare classifies 3 types of global surgical packages based on the number of post-operative days: 0-day (endoscopies and minor procedures), 10-day (other minor procedures), and 90-day (major procedures). Each has different rules for included pre- and post-operative care.
Modifier 24 is used for an unrelated E/M service during the postoperative period, while Modifier 79 is used for an unrelated procedure that happens during the postoperative period.
Modifier 24 is used for unrelated E/M services provided during the postoperative period, but not on the same day as a procedure. Modifier FT is used for unrelated E/M services provided on the same day as a procedure or another E/M service during the global period, such as critical care.
In the global surgery period, “Transfer of Care” is the formal handover of responsibility for a patient’s post-operative care from the surgeon to another healthcare provider. This process requires clear communication and documentation and is used to determine how providers are reimbursed for different parts of the patient’s care.
HCPCS code G0559 refers to a post-operative follow-up visit by a different physician who is not the original surgeon. This allows for separate reimbursement for follow-up care provided by an outside practitioner during a 90-day global period when there is no formal transfer of care.
No, post-operative care related to the surgery is generally included in the global surgical package and cannot be billed separately. However, exceptions exist, such as using HCPCS code G0559 for follow-up care provided by a different physician not in the same practice as the surgeon.
HCPCS code G0559 is used for post-operative follow-up care provided by a different physician, outside of the original surgeon’s practice, during the global period, and is reimbursable. CPT code 99024, on the other hand, is used for tracking post-operative visits provided by the same surgeon or their group and is not reimbursable.
Medicare recognizes situations where the original surgeon cannot provide follow-up care. HCPCS code G0559 allows a different physician to provide necessary post-operative care and be reimbursed separately, ensuring the patient receives timely and appropriate follow-up.
There is no specific limit, but each visit must be medically necessary and well-documented. Excessive or unjustified billing may be flagged during audits.
Yes, improper use can result in claim denials, financial penalties, and potential audits. If Medicare finds fraudulent use, providers may have to repay reimbursed amounts and face additional fines.
Don't Get Lost in Global Surgery Compliance
The complexities of global surgery rules can lead to costly denials. Let RxCredentialing handle the details. We help you stay on top of the latest coding changes to ensure you are accurately and fully reimbursed for the care you provide.
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