CurrentBlue Cross Blue Shield - MainePolicy G-06041

Global surgical package reimbursement

Defines AMH Health / Blue Cross Blue Shield - Maine reimbursement rules for the global surgical package, what services are included or separately reimbursable, and which supplementary global surgery indicator codes apply. Applies to providers submitting claims to the payer under member benefit plans.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyGlobal surgical package reimbursement

Policy CodePolicy G-06041

Change TypeClarified language

Effective DateJan 30, 2023

Next Review Date

Key ActionServices must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis and to the member's state of residence; follow proper billing and submission requirements.

SourceLink

POLICY UPDATE CHANGES

Updated policy language and clarified services included in and separately reimbursable from the global surgical package.

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

Pre/Intra/Postcomponents included

Listedseparately reimbursable

XXX/YYY/ZZZsupplementary indicators

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Global Surgical Package Coverage Criteria

Global surgical package coverage criteria

AMH Health allows reimbursement for the global surgical package; specific components are included and others are separately reimbursable.

Global surgical package reimbursed unless provider, state, federal, or CMS contracts indicate otherwise.

Included (ALL of the following are part of the global surgical package and not separately reimbursable when reported by the operating surgeon or providers in the same group with the same specialty):

Preoperative services rendered after the decision is made to operate (beginning the day before for major procedures; beginning the day of surgery for minor procedures).
Intraoperative services that are a usual and necessary part of the surgical procedure, including surgical kits, miscellaneous surgical services and supplies, fluid and drug administration (prophylactic and therapeutic drugs, local anesthetic injections, topical anesthesia, anesthetic blocks or agents, unspecified/unclassified drug codes administered by the operating provider), moderate sedation, and intraoperative pain management & devices.
Visits during the postoperative periods related to recovery from the surgery regardless of place of service, including postsurgical management by the surgeon and medical or surgical services for postoperative complications that do not require return to the operating room and are not categorized as a Hospital Acquired Condition (HAC) or Present on Admission (POA).

Separately reimbursable (ANY of the following may be billed separately):

The initial consultation or evaluation by the surgeon to determine the need for a major surgical procedure.
Services of other physicians (unless transfer of care is documented in a letter or an annotation in the discharge summary, hospital record, or ASC record).
Visits during the postoperative period that are unrelated to the diagnosis of the surgery unless they occur due to complications of the surgery.
Treatment for an underlying condition or an added course of treatment that is not part of normal recovery from surgery.
Clearly distinct surgical procedures during the postoperative period that are not reoperations or treatment for complications.

Coding and billing requirements

AMH Health follows CMS Global Surgery indicator codes, including supplementary indicators XXX, YYY, and ZZZ; global periods are 0, 10, or 90 days depending on the procedure.
The global surgical period for add-on codes is determined by the primary surgical code; standard correct coding applies.
Providers must use applicable HIPAA-compliant modifiers for any services provided during the postoperative period.

Documentation for unlisted procedures

Reimbursement for unlisted surgical procedures (YYY) is determined by individual claim review and requires documentation such as office notes and an operative report.

The global surgical package may be furnished in any setting and applies to both minor and major procedures as defined by their postoperative periods (0, 10, or 90 days).

Global Periods and Supplementary Indicator Codes

Supplementary global surgery indicatorsmixed

XXX	Codes that the global surgery concept does not apply
YYY	Unlisted surgical procedures / Health Plan/MAC determines global period (0, 10, or 90 days)
ZZZ	Add-on codes included in the global period of the primary service

Global periods

Global postoperative periods0, 10, or 90 days depending on the procedure

Applies toBoth minor and major surgical procedures as defined by their postoperative periods

Source standardAMH Health follows CMS Global Surgery indicator concepts for determining periods

Authorization, Documentation, and Prerequisites

Note

Obtain authorization and ensure medical necessity; follow billing/submission rules

Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis and to the member's state of residence; follow proper billing and submission requirements. The global surgical package is reimbursed unless provider, state, federal, or CMS contracts and/or requirements indicate otherwise.

Ensure services are authorized and medically necessary for the procedure and diagnosis and the member's state of residence.
Submit claims with appropriate CPT/HCPCS/revenue codes supported by medical records and office notes.
Be aware that contract, state, federal, or CMS requirements may supersede this policy and affect reimbursement.

Definitions Related to Global Surgical Package

Global Surgery (global surgical package)

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

Components includedPreoperative care (after decision to operate), intraoperative services, and postoperative care related to recovery and postsurgical management

ApplicabilityReimbursement applies to services furnished in any setting unless contracts or regulations indicate otherwise

Coding guidanceAMH Health follows CMS Global Surgery indicators and supplementary indicator codes (XXX, YYY, ZZZ)

Major procedures

DefinitionMajor procedures are codes that have a 90‑day global surgical period.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyGlobal surgical package reimbursement

Policy CodePolicy G-06041

Change TypeClarified language

Effective DateJan 30, 2023

Next Review Date

SourceLink

On This Page

Diagnostic tests and procedures.

Treatment for postoperative complications that require a return trip to the operating room.

Immunosuppressive therapy for an organ transplant.

A second procedure when a less extensive procedure fails and a more extensive procedure is required.

Critical care services unrelated to the surgery when the member is critically ill and requires constant attendance of the physician.

Clinic fees or other facility fees reported on a UB-04 associated with typical post-operative care.

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.

Preoperative timingFor major procedures, preoperative services included begin the day before surgery (per global surgery conventions)

Reimbursement noteGlobal surgical package reimbursement applies unless provider, state, federal, or CMS contracts indicate otherwise

Minor procedures

DefinitionMinor procedures are codes that have either a 0‑day or 10‑day global surgical period based on complexity.

Postoperative optionsPostoperative global period is 0 days for the least complex and 10 days for more complex minor procedures

Reimbursement applicabilityGlobal surgery package reimbursement applies to minor procedures unless superseded by contract or regulation

Unlisted surgical procedures (YYY)

Reimbursement determinationReimbursement for unlisted surgical procedures (YYY) is based on individual claim review by the Health Plan/MAC.

Required documentationClaims with unlisted codes must include office notes and an operative report for consideration during review.

Global period assignmentThe Health Plan/MAC determines the global period for YYY codes; it may be 0, 10, or 90 days.

Add-on surgical procedures (ZZZ)

DefinitionAdd-on surgical procedures (ZZZ) are codes related to another service (add-on codes) and are always included in the global period of the primary service.

Global period determinationThe global surgical period for an add-on procedure is based on the primary surgical code; standard correct coding applies.

Billing implicationAdd-on codes do not carry a separate global period and are reimbursed as part of the primary service's global package