CurrentAnthemPolicy G-06041

Global Surgical Package

Defines Anthem New York Medicaid reimbursement rules for the global surgical package, including which services are included and separately reimbursable, and who (operating surgeons and same-group providers/NPPs) is affected.

Policy Summary

PayerAnthem

PolicyGlobal Surgical Package

Policy CodePolicy G-06041

Change TypeNo material change

Effective DateJan 30, 2023

Next Review Date

Key ActionVerify that services meet authorization and medical necessity guidelines and confirm the member's benefit plan and state requirements.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

NY Medicaidjurisdiction

0/10/90postoperative period lengths

06/03/2025last review

Included vs Separateservice categories

Global Surgical Package Coverage Rules

Global surgical package coverage rules

Reimbursement rules for the global surgical package and delineation of included versus separately reimbursable services.

The health plan allows reimbursement for the global surgical package following CMS global surgery indicator codes (including XXX, YYY, ZZZ) and applies to minor and major procedures with postoperative periods of 0, 10, or 90 days.

Included services

Preoperative services rendered after the decision is made to operate (beginning the day before surgery for major procedures; beginning the day of surgery for minor procedures).
E/M services rendered after the decision for surgery has been made.
Intraoperative services normally part of the surgical procedure, including miscellaneous surgical services and supplies (e.g., surgical kits).

Policy Summary

PayerAnthem

PolicyGlobal Surgical Package

Policy CodePolicy G-06041

Change TypeNo material change

Effective DateJan 30, 2023

Next Review Date

Key ActionVerify that services meet authorization and medical necessity guidelines and confirm the member's benefit plan and state requirements.

SourceLink

On This Page

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Separately reimbursable services

The initial consultation or evaluation by the surgeon to determine need for a major surgical procedure.
Services of other physicians, except when there is a documented transfer of care (letter or annotation in discharge summary, hospital record, or ASC record).
Visits during the postoperative period that are unrelated to the diagnosis of the surgery (unless due to surgical complications).
Treatment for an underlying condition or an added course of treatment that is not part of normal recovery.
Diagnostic tests and procedures.
Clearly distinct surgical procedures during the postoperative period that are not re-operations or treatment for complications.
Treatment for postoperative complications that require a return trip to the operating room.
A second procedure when a less extensive procedure fails and a more extensive procedure is required.
Immunosuppressive therapy for an organ transplant.
Critical care services unrelated to the surgery where the member is critically ill and requires constant attendance of the physician.
Physical therapy, occupational therapy, and speech therapy.
Surgical clearance from a provider other than the treating physician when there is a high risk of comorbidity.

Codes, Indicators, and Documentation

Global surgery indicator codesCPT

XXX	Codes the global surgery concept does not apply
YYY	Unlisted codes where health plan determines the global period (0,10,90 days)
ZZZ	Add-on codes included in primary service global period

Documentation for unlisted procedure review

Required documentationWritten description of the procedure, office notes, and an operative report must be submitted with claims for unlisted surgical codes for individual claim review.

Review basisReimbursement for unlisted surgical procedures (YYY) is determined on an individual claim basis following submission of the required documentation.

Submission expectationProvide clear, specific operative details in the written description to allow clinical review and determination of appropriate global period and reimbursement.

Authorization, Medical Necessity, and Billing Actions

Prior Authorization

Verify authorization, medical necessity, and member benefits before billing

Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis; verify the member's benefit plan and state requirements before submitting claims. Use proper billing and submission guidelines, including industry-standard CPT, HCPCS, and/or revenue codes, and ensure services billed are fully supported in the medical record and/or office notes; failure to follow coding/billing guidelines may result in claim rejection, denial, adjustment, or recovery of payment.

Confirm prior authorization and medical necessity per the member's benefit plan and state of residence.
Ensure claims use correct CPT/HCPCS/revenue codes and that documentation (medical record/office notes) supports billed services.
Be aware noncompliance may lead to claim rejection or denial, payment recovery/recoupment, or reimbursement adjustment.

Key Definitions

Global Surgical Package — definition

DefinitionThe global surgical package includes all necessary services normally furnished by a surgeon before, during, and after a procedure.

ScopeApplies to both minor and major procedures with postoperative periods described as 0, 10, or 90 days (per CMS/global indicators).

IncludesPreoperative evaluation after decision to operate, intraoperative services and supplies, and postoperative visits related to recovery.

Major procedures — 90-day global period

Global period lengthCodes designated as major procedures have a 90-day global surgical period.

Typical services coveredPostoperative care related to recovery and routine follow-up included within the 90-day period.

Coding noteMajor procedure codes are identified by CMS/global surgery indicators; standard correct coding applies.

Minor procedures — 0-day or 10-day global period

Global period optionsMinor procedures have either a 0-day or a 10-day global surgical period based on procedure complexity.

0-day minor proceduresTypically simple procedures with no postoperative global days; postoperative care billed separately when unrelated to surgery diagnosis.

10-day minor proceduresProcedures of greater complexity than 0-day minors but less than major procedures; postoperative care included for 10 days.

YYY — plan/MAC-determined global period

Indicator meaningYYY indicates the health plan or MAC determines the global period for the code; the period may be 0, 10, or 90 days.

Review processFor YYY codes, the global surgical period is assigned following individual claim review and may require submission of supporting documentation for unlisted procedures.

Relation to CMSUsed when the standard CMS global surgery indicator does not prescribe a definitive global period and plan/MAC determination is necessary.

ZZZ — add-on codes included in primary global period

DefinitionZZZ denotes an add-on code related to another service and is always included in the global period of the primary service.

Global period assignmentThe global surgical period for an add-on (ZZZ) is determined by, and follows, the primary surgical code's global period.

Billing implicationAdd-on codes included in the primary service global period are not separately reimbursable outside that period unless documentation supports a separate, unrelated service.