CurrentAnthemPolicy G-06041

Global Surgical Package

Defines Anthem Medicare Advantage reimbursement rules for the global surgical package (pre-, intra-, and postoperative services) including what is included and separately reimbursable; applies to providers submitting claims to Anthem Medicare Advantage.

Policy Summary

PayerAnthem

PolicyGlobal Surgical Package

Policy CodePolicy G-06041

Change TypeClarified language; added supplementary indicator codes

Effective Date01/30/2023

Next Review Date

Key ActionSubmit required documentation (written description, office notes, operative report) with claims for unlisted procedures (YYY) and use applicable HIPAA-compliant modifiers when billing postoperative services.

SourceLink

POLICY UPDATE CHANGES

Updated policy language, included supplementary indicator codes (XXX, YYY, ZZZ), clarified services included and separately reimbursable, and added definitions and related policy references.

0,10,90standard postoperative global periods (days)

G-06041policy number

01/30/2023effective / last approval date

Global Surgical Package — What Is Included and Excluded

ALL of the following

Preoperative services after decision to operate: beginning the day before for major procedures, beginning the day of surgery for minor procedures.
E/M services rendered after the decision for surgery has been made are included.
Intraoperative services that are usual/necessary parts of the procedure, including supplies, kits, fluid/drug administration, therapeutic/prophylactic drugs, local/topical anesthetics, anesthetic blocks/agents, unspecified drug codes administered by the operating provider, intraoperative pain management/devices, and moderate sedation.
Visits during the postoperative period related to recovery from the surgery regardless of place of service.
Medical or surgical services due to postoperative course that do not require additional trips to the operating room and are not categorized as a Hospital-Acquired Condition (HAC) or Present on Admission (POA).
Postsurgical pain management by the surgeon.

Policy follows CMS Global Surgery indicators and applies to minor and major procedures with standard global periods of 0, 10, or 90 days.

Services Separately Reimbursable from Global Package

Services that are not included in the global surgical package and may be billed separately.

ANY of the following

Initial consultation or evaluation by the surgeon to determine need for a major procedure.
Services of other physicians except when there is a documented transfer of care agreement (letter or annotation in discharge/ASC/hospital 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 additional course of treatment not part of normal recovery.
Diagnostic tests and procedures.
Clearly distinct surgical procedures during postoperative period that are not reoperations or treatment for complications.
Treatment for postoperative complications requiring a return to the operating room.
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 patient is critically ill and requires constant attendance.
Physical Therapy, Occupational Therapy and Speech Therapy.
Clinic fees or other facility fees reported on UB-04 associated with typical post-operative care.
Surgical clearance from a provider other than the treating physician when there is high risk comorbidity.

Providers must use applicable HIPAA-compliant modifiers for any services provided during the postoperative period; claims with unlisted codes (YYY) require written description, office notes, and an operative report for review.

Global Surgery Indicator Codes and Groupings

Global Surgery Supplementary Indicatorsmixed

XXX	Codes where the global surgery concept does not apply.
YYY	Unlisted surgical procedures — Health Plan/MAC determines the global period (0, 10, or 90 days) and review is on an individual claim basis.
ZZZ	Add-on codes: code related to another service and always included in global period of the primary service.

This policy follows the CMS Global Surgery indicator codes and applies specifically to Anthem Medicare Advantage claims. Providers must submit claims using standard industry coding (CPT/HCPCS) and appropriate HIPAA-compliant modifiers when applicable. The policy applies to both participating and non‑participating professional providers and facilities unless otherwise noted.

Improper or noncompliant coding and billing may result in claim rejection, denial, payment recovery/recoupment, or adjustment of reimbursement to reflect the appropriate services performed. For unlisted procedures (YYY), claims must include a written description, office notes, and an operative report to be considered during review.

Documentation and Billing Rules Providers Must Follow

Documentation Required

Documentation required for unlisted procedures (YYY)

Claims submitted with unlisted surgical procedure codes (YYY) must include supporting documentation for consideration during review.

Affected codes: YYY
Required documentation: a written description, office notes, and an operative report

Billing Rule

Use applicable HIPAA-compliant modifiers during postoperative period

When billing for services provided during the postoperative period, providers must append and submit the applicable HIPAA-compliant modifier(s) as required by coding guidelines.

Documentation Required

Transfer of care documentation when other physicians bill separately

If services furnished by other physicians are billed separately from the operating surgeon, providers must document a transfer of care agreement to support separate reimbursement.

Acceptable forms: a transfer of care agreement letter
Or: an annotation in the discharge summary, hospital record, or ASC record

Scope and Purpose

This policy defines Anthem Medicare Advantage reimbursement rules for the Global surgical package—the preoperative, intraoperative, and postoperative services normally furnished by a surgeon—and follows CMS global surgery indicators including the supplementary indicators XXX, YYY, and ZZZ. Reimbursement applies for procedures with standard postoperative global periods of 0, 10, or 90 days depending on the procedure.

Included services consist of preoperative care after the decision to operate (beginning the day before for major procedures and the day of surgery for minor procedures), intraoperative services and supplies that are usual and necessary to the procedure (for example, surgical kits, therapeutic/prophylactic drugs, local/topical anesthetics, anesthetic blocks, intraoperative pain management and moderate sedation), and visits during the postoperative period related to recovery from the surgery. Services performed by the operating surgeon or providers in the same group and specialty are considered part of the global package.

Services that may be billed separately include the initial consultation to determine the need for major surgery, services of other physicians unless there is a documented transfer of care, diagnostic tests, clearly distinct subsequent procedures during the postoperative period, treatment requiring return to the operating room, and other items specifically listed as separately reimbursable. Providers must follow documentation and modifier requirements described in the policy when billing separately reimbursable services.

Key Terms

Definitions

Global surgical package (global surgery)All necessary services normally furnished by a surgeon before, during, and after a procedure.

Major proceduresCodes that have a 90-day global surgical period.

Minor proceduresCodes that have either a 0-day or 10-day global surgical period based on complexity.

MMMMaternity codes; usual global period doesn't apply.

XXXCodes that the global surgery concept does not apply to.

YYYCodes where the Health Plan/MAC determines the global period; the global period will be 0, 10, or 90 days; reimbursement for unlisted procedures is reviewed on an individual claim basis and requires a written description, office notes, and an operative report.

ZZZAdd-on code related to another service and is always included in the global period of the primary service.

Preoperative carePreparation and management of a patient prior to surgery; preoperative services after the decision to operate begin the day before for major procedures and the day of surgery for minor procedures.

Postoperative careCare received after the surgery that is related to recovery from the surgery; visits during the postoperative period related to recovery are included in the global package regardless of place of service.

Policy Updates

01/30/2023clarifiedLatest

Review approved and effective 01/30/2023 — policy language updated with minor clarifying changes; services included in and separately reimbursable from the global surgical package were updated; definitions and supplementary indicator codes (XXX, YYY, ZZZ) and related policy references were added.