CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPO14

Global Surgical Package-Professional Providers

Reimbursement and coding rules for the global surgical package (pre-, intra-, and post-operative services) for professional providers (physicians and other qualified health care professionals) under BCBSNM plans; governs coding, allowable separate reimbursement, modifiers, and included/excluded services.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyGlobal Surgical Package-Professional Providers

Policy CodePolicy CPCPO14

Change TypeAnnual review

Effective DateJanuary 22, 2024

Next Review Date

Key ActionMaintain accurate documentation to support billed services and append appropriate modifiers when billing services that are not part of the global surgical package; submit supporting documentation upon request to substantiate separate reimbursement.

SourceLink

POLICY UPDATE CHANGES

Policy shows annual review history with most recent clinical payment and coding committee approval on January 12, 2024 and plan effective date January 22, 2024.

000,010,090Global Days Values referenced

92Total global period (major procedures)

11Total global period (010 indicator)

Policy Snapshot

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This policy from Blue Cross Blue Shield of New Mexico (BCBSNM) defines reimbursement and coding rules for the global surgical package covering pre-operative, intra-operative, and post-operative professional services for physicians and other qualified health care professionals. It applies to services billed under BCBSNM plans and explains how the Plan uses CMS-defined global periods (Global Indicators 000, 010, and 090) to determine when services are included in the global package versus eligible for separate reimbursement, the use of appropriate modifiers to report split or unrelated services, and expectations for documentation and claims submission.

Eligibility and Included/Excluded Services

Eligibility for separate reimbursement during global period

Conditions under which services may be eligible for separate reimbursement despite occurring in the global period.

ANY of the following

Service provided after the global period expires (based on the procedure's Global Days Value).
Service is a clearly distinct surgical procedure during the postoperative period which is not a repeat operation or treatment for complications.
Treatment for postoperative complications requiring return to the operating room.
A second, more extensive procedure performed because a less extensive procedure has failed.
Services performed by other physicians when care is transferred and documentation supports transfer of care.
Significant, separately identifiable E/M service unrelated to the decision to perform a minor surgical procedure (requires modifier -25).
Critical care services unrelated to the surgical procedure for a critically ill/injured member.

When global package includes services

Services and items generally included in the global surgical package and therefore not separately payable.

ALL of the following

Pre-operative visits as defined (day before for major; day of for minor procedures).
Intra-operative services usual and necessary to the procedure (includes administration of fluids/drugs during operative procedure; CPT 96360-96377 not separately reported for operative procedure).
Immediate post-operative care, dictation of operative notes, communication with family/other clinicians, writing orders, evaluation in recovery.
Post-operative follow-up care during the global period related to recovery, including follow-up E/M visits (unless significant and separate).

Maximum reimbursement for split surgical packageTotal eligible reimbursement for split services must not exceed 100% of the total global surgical allowable amount

Codes, Modifiers, and Reporting Guidance

Global Days / IndicatorsCPT|HCPCS

Global Indicator 000	No pre- or post-operative days; day of surgery only
Global Indicator 010	Day of surgery + 10 post-op days (total 11 days); no pre-op period
Global Indicator 090	1 day pre-op + day of surgery + 90 post-op days (total 92 days)

Modifiers referenced for split/unrelated servicesModifier

24	Unrelated E/M service by same physician during postoperative period
25	Significant, separately identifiable E/M service by same physician on same day as procedure
54	Surgical care only
55	Post-operative management only
56	Pre-operative management only
57	Decision for surgery
58	Staged or related procedure during postoperative period
76	Repeat procedure by same physician
77	Repeat procedure by another physician
78	Unplanned return to OR by same physician for related procedure

1–10 of 12

1/2

Example CPT blockCPT

96360-96377

Therapeutic, prophylactic, and diagnostic injections/infusions - noted as not separately reported during the operative procedure

BCBSNM uses the CMS-defined global periods when determining the pre-, intra-, and post-operative timeframe applicable to a procedure and advises providers to refer to the CMS resources and the Medicare NCCI Policy Manual for a complete list of CPT/HCPCS codes and global period assignments. For guidance on modifier use, providers should also consult the BCBSNM CPCPO23 Modifier Reference Policy and the referenced CMS publications to ensure correct modifier-to-procedure combinations and reporting during global periods.

Documentation and Billing Requirements

Documentation Required

Maintain and submit documentation upon request

Providers must maintain accurate medical records supporting services billed and be prepared to submit supporting documentation upon request. BCBSNM may request documentation to adjudicate whether billed services qualify for separate reimbursement, including when modifiers are appended or care is transferred or complications occur.

Documentation of transfers of care when services are provided by another physician/QHP (see Split Surgical Package guidance)
Documentation of treatment for postoperative complications (e.g., return to OR)
Medical record justification when modifiers are appended to indicate services are not part of the global package

Billing Rule

Append appropriate modifiers to indicate services not part of global package

Append appropriate CPT/HCPCS modifiers to indicate services that are not part of the global surgical package; incorrect modifier-to-procedure combinations may lead to claim denials and require corrected claim submission.

Billing Rule

Code using HIPAA-approved code sets

Submit claims using valid HIPAA‑approved code sets and follow industry coding guidelines; claims are subject to code edits and review under CMS NCCI/CCI edits and other coding protocols.

UB (Uniform Billing)
CPT (AMA Current Procedural Terminology)
HCPCS
ICD-10 CM/PCS
NDC (National Drug Codes)
DRG guidelines
CMS NCCI/CCI edits

Documentation Required

Separate E/M services within global period

When billing a significant, separately identifiable E/M service during the global period, document clearly why the visit is unrelated to the surgical procedure or constitutes a separate identifiable service; append modifier 24 or 25 as appropriate.

Modifiers to use: 24, 25
Medical record must clearly document that the E/M visit is unrelated to the surgery or is a separately identifiable service

Billing Rule

Split surgical package billing limits

When pre- and/or post-operative services are split between providers, append appropriate modifiers to identify who provided each service and allocate reimbursement so that total eligible reimbursement does not exceed 100% of the global surgical allowable.

Total eligible reimbursement for split services must not exceed 100% of the total global surgical allowable amount

Clinical and Administrative Context

The global surgical package (also called global surgery) includes all routine and necessary services and supplies related to a procedure when rendered by the surgeon or other providers of the same group and specialty, across the pre-operative, intra-operative, and post-operative timeframes. BCBSNM applies the global package in all settings (office, ASC, outpatient and inpatient) and specifically identifies what is included — for example, pre-operative visits as defined by procedure type, intra-operative services and routine administration of fluids/drugs (CPT codes 96360-96377 are not separately reported when part of the operative procedure), immediate post-operative care, follow-up visits during the global period, postsurgical pain management by the surgeon or same-group providers, routine supplies and miscellaneous services (dressing changes, suture removal, catheter care, etc.), and surgical suite/anesthesia equipment when applicable.

Key Terms

Global surgical package (global surgery)All related services and supplies that are routine and necessary to the procedure (preoperative, intra-operative, and postoperative) rendered by the provider or another physician/QHP of same group and specialty/subspecialty.

Global periodThe time encompassing pre-operative, intra-operative and post-operative days as defined by the procedure's Global Days Value (e.g., 000, 010, 090).

Split surgical packageWhen pre-operative and/or post-operative services are rendered by a physician or QHP other than the surgeon performing the procedure; requires appropriate modifiers and has reimbursement allocation limits.

Policy Update Changes

January 12, 2024annual reviewLatest

Clinical payment and coding committee approved the policy on January 12, 2024, with a plan effective date of January 22, 2024 (policy shows annual review history; no explicit material clinical/coding changes).

06/21/2023annual review

Annual review documented in policy update history.

03/01/2022annual review

Annual review documented in policy update history.

05/11/2021annual review

Annual review documented in policy update history.

04/30/2020annual review

Annual review documented in policy update history; disclaimer update noted.

02/15/2019annual review

Annual review documented in policy update history.

02/08/2018new policy

Policy created (new policy effective date recorded in update history).

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyGlobal Surgical Package-Professional Providers

Policy CodePolicy CPCPO14

Change TypeAnnual review

Effective DateJanuary 22, 2024

Next Review Date

SourceLink

On This Page

Global Surgical Package-Professional Providers

Policy Snapshot

Eligibility and Included/Excluded Services

Codes, Modifiers, and Reporting Guidance

Documentation and Billing Requirements

Clinical and Administrative Context

Key Terms

Additional References

Policy Update Changes