The Global Periods
Each procedure in the Physician Fee Schedule has a global indicator. Major procedures carry a 90-day global period, which also includes the day before surgery. Minor procedures carry a 0 or 10 day global period. Endoscopies and some other procedures have a 0-day global.
What The Package Includes
- Pre-operative visits the day before or the day of a major procedure, after the decision for surgery
- The procedure itself and routine intraoperative services
- Complications after surgery that do not require a return to the operating room
- Routine post-operative visits, dressing changes and suture removal
- Post-operative pain management by the surgeon
Modifiers For Work Outside The Package
- 24: unrelated E/M visit during a post-operative period
- 25: significant, separately identifiable E/M on the same day as a minor procedure
- 57: E/M visit that resulted in the decision for major surgery, on the day of or day before
- 58: staged or related procedure, or more extensive procedure, during the post-operative period
- 78: unplanned return to the operating room for a related procedure during the post-operative period
- 79: unrelated procedure during the post-operative period
Split Care
When one physician performs the surgery and another provides post-operative care, modifiers 54 (surgical care only), 55 (post-operative management only) and 56 (pre-operative management only) divide the global payment. Both providers need a documented transfer of care.
What Is Changing
CMS has been revisiting global surgery valuation. In the CY 2027 Physician Fee Schedule final rule, CMS finalized a 20 percent payment reduction for the lower-paid service when an office visit and a minor procedure occur on the same day. Practices should review how this affects procedures they commonly perform with a same-day visit.
Frequently Asked Questions
- Is a visit for a wound infection after surgery billable?
- Not if it is treated without returning to the operating room. Complications managed in the office are included in the global package for Medicare.
- Do commercial payers follow the same globals?
- Many do, but some use their own global periods or modifier rules. Check the payer's policy.
Billing Support For This Specialty
Physicians Professional Billing Services, Inc. has billed wound care, surgical and procedural specialties since 1998, across every Medicare Part B MAC jurisdiction.
Primary Sources
This page is general information about billing and coverage rules and is not legal, coding or reimbursement advice for a specific claim. Coverage policies change; confirm current requirements with CMS and the applicable Medicare Administrative Contractor.