CurrentColorado Rocky Mountain Health PlansPolicy N/A

Global Surgical Package and Modifiers (post-operative billing)

Rules for billing and reimbursement of procedures and E/M services during surgical global periods, including use and payment implications of modifiers -24, -25, -58, -78, -79 and -FT for Colorado Rocky Mountain Health Plans (UnitedHealthcare Medicare Advantage). Affects physicians and groups billing Medicare Advantage claims.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyGlobal Surgical Package and Modifiers (post-operative billing)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionAppend the appropriate modifier (e.g., -24, -58, -78, -79, -FT) and supporting documentation when billing services during a surgical global period to indicate unrelated or staged procedures and allow separate reimbursement when criteria are met.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

000,010,090Global Days Values referenced

24,25,58,78,79,FTModifiers listed

Field18/34-35MPFS fields referenced

4/1/2026Last review

When Services Are Reimbursed During a Global Period

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Reimbursement criteria for services during global periods

Conditions under which services performed during a global surgical period may be reimbursed separately:

ANY of the following

Modifier -79: procedure during the post-operative period that is unrelated to the original procedure may be billed and begins a new post-operative period when documentation supports lack of relation.
Modifier -24: E/M service during the post-operative period that is unrelated to the original procedure may be paid if documentation supports that the E/M is unrelated to the original procedure.

Modifier -78: return to the operating room for treatment of postoperative complications; report the CPT code that describes the procedure(s) performed on the return trip and append modifier -78.

Payment when -78 applies: determine percentage of the global package for intra-operative services from MPFS Field 18; multiply the fee schedule amount (Field 34 or 35) by this intra-operative percentage and round to the nearest cent; procedures with a '000' global period billed with -78 are paid at full value.

Limits on -78 reductions: a -78 payment reduction will not be applied to procedures with Global Days Value other than 010 or 090; a -78 reduction will not be applied to a 010 or 090 code that lacks an Intraoperative Percentage in the NPFS.

When no specific CPT code exists for the return-to-OR procedure, report an unspecified procedure code in the correct series (e.g., 47999 or 64999); do not report the original surgery code unless the identical procedure is repeated.

Modifier -58: staged or related procedures (planned, more extensive, or procedures performed as therapy after diagnostic surgery) may begin a new post-operative period when billed with -58.

Critical care (CPT 99291/99292 + modifier -FT) provided during the global period may be paid separately when the patient is critically ill, the care is above and beyond and unrelated to the surgical procedure, and documentation (including an ICD-10 code indicating an unrelated condition) supports this.

Same-TIN/same-specialty rule: any procedure with Global Days Value 000, 010, or 090 performed during the postoperative period by a clinician of the same TIN and specialty as the original surgeon is considered included in the original global package and is not separately reimbursable unless an appropriate modifier (58, 78, or 79) is reported and supported by the record.

Multiple procedure/global period effects: a procedure meeting -78 requirements will not establish a new global period and multiple procedure reductions will not be applied when -78 is reported.

Same-day E/M with procedure: append modifier -25 to report a significant, separately identifiable E/M service on the same day as a procedure; UnitedHealthcare does not require two distinct diagnosis codes for reimbursement though additional diagnoses may be reported.

Modifiers, Codes, and Payment Calculations

Relevant modifiersModifier

24	Unrelated E/M service during postoperative period
25	Significant, separately identifiable E/M service on same day as procedure
57	Decision for surgery
58	Staged or related procedure during postoperative period
78	Return to OR for related procedure during postoperative period
79	Unrelated procedure or service by same physician during postoperative period
FT	Modifier used with critical care codes to indicate unrelated critical care
RT	Right side (laterality)
LT	Left side (laterality)

Intraoperative percentage requirement — MPFS field guidance for applying -78 reduction and lookup fields

Applicable Global Days-78 payment reduction applies only when the CPT code has a Global Days Value of 010 or 090

MPFS field for intra-op percentageRefer to MPFS Field 18 to determine the intraoperative percentage used for -78 calculations

Fee schedule multiplicationMultiply the fee schedule amount (Field 34 or 35 of the MFSDB) by the intraoperative percentage and round to the nearest cent

000 global period exceptionWhen a procedure has a '000' global period and is billed with -78, pay the full value since these codes lack pre-, intra-, and postoperative values

Billing Actions and Modifier Use for Providers

Billing Rule

Unrelated procedure or E/M by same physician during post-op period

Use modifier -79 when a procedure or service performed during the postoperative period is unrelated to the original surgery. Use modifier -24 when an E/M service during a postoperative period is unrelated to the original surgery. Documentation must support that the E/M service is not related to postoperative care. When an unrelated procedure is billed with modifier -79, a new postoperative period begins.

Modifier -79: Procedure unrelated to original surgery — apppend to subsequent procedure; starts a new post-operative period when billed.
Modifier -24: Significant, separately identifiable E/M service unrelated to postoperative care — must include supporting documentation.

Billing Rule

Staged/related procedures (modifier -58)

Append modifier -58 for staged or related procedures performed by the same physician during the postoperative period when the procedure was planned at the time of the original procedure, is more extensive than the original, or is therapeutic following a diagnostic surgical procedure. Reporting -58 with the staged procedure's CPT code indicates the procedure initiates a new postoperative period.

Modifier -58: Use for staged, planned, or more extensive procedures or therapy after diagnostic surgery — append to the staged procedure CPT code.
A new postoperative period begins when the next procedure in the staged series is billed with -58.

Key Definitions

Global Surgical Package — definition and scope of the global package

DefinitionThe Global Surgical Package includes preoperative visits (day before for major procedures; day of for others), services normally part of the procedure, complications not requiring return to the OR, postoperative visits related to recovery, post-procedure pain management, supplies (except exclusions), and miscellaneous services such as dressing changes and removal of sutures/staples

Scope — included servicesIncludes additional medical/surgical services required during postoperative period for complications not requiring additional OR trips

Scope — postoperative careIncludes postoperative visits, post-procedure pain management, and routine supplies and miscellaneous services related to recovery

Intraoperative Percentage — definition used to calculate payment when modifiers affect intra-op portion

DefinitionIntraoperative Percentage: percentage of the Global Surgical Package attributed to intraoperative services; used to calculate payment when modifier -78 is appended for return-to-OR related procedures

Calculation sourceDetermine the intraoperative percentage from Field 18 of the MPFS

Payment applicationMultiply the fee schedule amount (Field 34 or 35) by the intraoperative percentage and round to the nearest cent when -78 applies

Major/Minor Procedure — definition distinguishing major (090) vs minor (000/010) global day values

Major ProcedureA procedure having a Global Days Value of 090

Minor ProcedureA procedure having a Global Days Value of 000 or 010

ImplicationGlobal Days Value determines inclusion in the global package and applicability of payment rules such as -78 reductions