CurrentBlue Cross Blue Shield - IllinoisPolicy CPCP014

Global Surgical Package-Professional Provider

This Blue Cross Blue Shield of Illinois clinical payment and coding policy governs billing and coding for professional provider claims related to the global surgical package, describing included/excluded services, global periods, modifiers, and reimbursement considerations for providers submitting claims for eligible members.

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyGlobal Surgical Package-Professional Provider

Policy CodePolicy CPCP014

Change TypeAdded G0559editorial updates

Effective DateApril 15, 2025

Next Review Date

Key ActionPlan may request supporting documentation; providers should submit additional documentation upon request and ensure claims are coded per policy for review.

SourceLink

POLICY UPDATE CHANGES

New code section added for G0559

Grammatical updates; Additional Resources updated; References updated

000,010,090Global Days Values referenced

92Major procedure global period

11Minor procedure global period

G0559HCPCS add-on code added

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Global Surgical Package Coverage Criteria

Global surgical package coverage criteria

Criteria determining which services are included in the global surgical package, which are excluded, and rules for modifier usage and split-package billing:

ALL of the following

Pre-operative visits: starting the day before surgery for major procedures and the day of surgery for minor procedures.
Evaluation and management (E/M) services for minor surgery on the day of the minor surgery (included in Global Days Value 000-010).
Local infiltration, tumescent anesthesia, metacarpal/metatarsal/digital block, or topical anesthesia.
Intra-operative services usual and necessary to the surgical procedure (includes administration of fluids and drugs during or for the operative procedure; certain chemotherapy/infusion CPT codes are not separately reported for the operative procedure).
Immediate post-operative care including dictating operative notes, communicating with family and other clinicians, writing orders, and evaluating the member in the post-anesthesia recovery area.
Post-operative follow-up care during the designated global period related to recovery, including follow-up E/M visits occurring within the global period (except significant, separately identifiable E/M services unrelated to the decision to perform a minor surgical procedure which may be reported separately with modifier -25).
Surgical suite or anesthesia equipment used for the procedure.
Postsurgical pain management when performed by the surgeon, same specialty/subspecialty physician, or other QHP within the same group.
Supplies used for the procedure, except those specifically identified as exclusions.
Miscellaneous routine services such as dressing changes; local incisional care; removal of operative pack; removal of sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion/irrigation/removal of urinary catheters; routine peripheral IV lines; nasogastric and rectal tubes; and changes/removal of tracheostomy tubes.

ANY of the following

Initial consultation or evaluation by the surgeon to determine the need for major surgery.
Services performed by other physicians unless care is transferred to the other physician(s) with documentation of the transfer of care submitted for reimbursement consideration.
Visits unrelated to the diagnosis for the surgical procedure (unless performed due to complications of the surgery).
Treatment of the underlying condition or added courses of treatment not part of the normal recovery from surgery.
Diagnostic tests and procedures, including diagnostic radiological services.
Clearly distinct surgical procedures during the post-operative period that are not a repeat operation or treatment for complications (these may be separately eligible).

ALL of the following

Append modifiers to CPT/HCPCS codes to indicate whether a service is part of or separate from the global period; services separate from the global period may be eligible for reimbursement.
Claims may be denied for inappropriate modifier-to-procedure code combinations; corrected claims with the appropriate modifier-to-procedure code combination will be required for reimbursement consideration.
Modifier 24 and/or 25 should not be appended to codes for services rendered during the global period unless the medical records support that the visits were separate and unrelated (modifier 25 for significant, separately identifiable E/M on same day as procedure).
Examples of modifiers that may be appended include (not all-inclusive): 24 (unrelated E/M by same physician/QHP during postoperative period); 25 (significant, separately identifiable E/M same day of procedure); 54 (surgical care only); 55 (post-operative management only); 56 (pre-operative management only); 57 (decision for surgery); 58 (staged or related procedure); 76/77 (repeat procedures); 78 (unplanned return to OR for related procedure); 79 (unrelated procedure during postoperative period); FT (unrelated critical care E/M during postoperative period; FT may only be appended to critical care codes).

ALL of the following

When pre- and/or post-operative services are rendered by a physician or QHP other than the surgeon, appropriate modifiers must be appended to the same procedure code by each physician/QHP to identify the services provided.
Combined reimbursement to all physicians/QHPs for the global package must not exceed 100% of the global allowable; documentation of transfer of care is required to support separate reimbursement when applicable.

ALL of the following

Report HCPCS add-on code G0559 in addition to an office or outpatient E/M code without modifier 55 when post-operative care during a 90-day global period is rendered by a physician/QHP not in the same group and no formal transfer of care is established.

ANY of the following

000 = day of surgery only.
010 = day of surgery plus 10 days.
090 = day before surgery, day of surgery, plus 90 days.

ANY of the following

Postoperative services included in the global professional rate are not separately reimbursed unless excluded above or otherwise eligible; services after the global period may be eligible for separate reimbursement.
The Plan may request supporting documentation; providers are urged to submit additional documentation upon request and claims are subject to review against benefit coverage, provider contracts, and medical and coding policies.

Key Definitions

Definition of Global Period

DefinitionA global period is the time span covering pre-operative, intra-operative, and post-operative services as defined per procedure; Plan uses CMS-defined global periods.

Pre-operative visitsBegin either the day before surgery for major procedures or the day of surgery for minor procedures.

Intra-operative servicesServices that are normally a usual and necessary part of the surgical procedure.

Post-operative visitsFollow-up visits during the post-operative period related to recovery from surgery.

Definition of Global Surgical Package

ScopeAll related routine and necessary services and supplies that are routine and necessary to the procedure, rendered by the provider or another physician/QHP within the same group and/or same specialty/sub-specialty for pre-operative, intra-operative, and post-operative care.

SettingsApplies in inpatient, outpatient, Ambulatory Surgery Center (ASC), and professional provider office settings.

Included examplesFollow-up E/M visits related to recovery, surgical supplies (except specified exclusions), routine post-op items (dressing changes, suture removal), and postoperative pain management by surgeon/same specialty/group.

Definition of Split Surgical Package

Split surgical package definitionOccurs when pre-operative and/or post-operative services are rendered by a physician or QHP other than the surgeon performing the procedure; appropriate modifiers should be appended by each provider to the same procedure code to identify provided services.

Reimbursement capEligible reimbursement for a split surgical service must not exceed 100% of the total global surgical allowable amount.

Example percentage allocationsModifier percentage examples: Modifier 54 = 75%; Modifier 55 = 12.5%; Modifier 56 = 12.5%; Total = 100%.

OpenPayer

Global Surgical Package-Professional Provider

Global Surgical Package Coverage Criteria

Global Period Indicators, Modifiers, and Durations

Documentation and Claim Review (Provider Responsibilities)

Key Definitions

24	Unrelated E/M service by the same physician or other QHP during a postoperative period.
25	Significant, separately identifiable E/M service by the same physician or other QHP on the same day of the procedure or other service.
54	Surgical care only.
55	Post-operative management only.
56	Pre-operative management only.
57	Decision for surgery.
58	Staged or related procedure or service by the same physician or other QHP during the postoperative period.
76	Repeat procedure or service by same physician or other QHP.
77	Repeat procedure by another physician or other QHP.
78	Unplanned return to the operating/procedure room by the same physician or other QHP following initial procedure for a related procedure during the postoperative period.