CurrentEmpire BluecrossPolicy C-08007

Global Surgical Package (Professional) Reimbursement

Defines Anthem/Empire BlueCross reimbursement rules for the global surgical package (professional) including which services are included or separately reimbursable and applicable coding indicators; applies to commercial professional providers submitting claims to the payer.

Policy Summary

PayerEmpire Bluecross

PolicyGlobal Surgical Package (Professional) Reimbursement

Policy CodePolicy C-08007

Change TypeRevised (material)

Effective Date06/14/2023

Next Review Date

Key ActionFollow authorization and medical necessity guidelines appropriate to the procedure and diagnosis; state and federal law and contract language take precedence.

SourceLink

POLICY UPDATE CHANGES

Updated YYY codes per CMS updates and revised language items Included in Surgical Package; updated Definitions and Related Policy section.

0,10,90standard postoperative periods described

YYYYYY category present

C-08007document identifier

2023-06-14last approval

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Global Surgical Package Coverage Criteria

Anthem reimburses the global surgical package; services included in the package are not eligible for separate reimbursement when reported by the operating surgeon or by providers in the same group with the same specialty. The Health Plan follows CMS global surgery indicator codes and supplementary indicators (MMM, XXX, YYY, ZZZ).

Global surgical package reimbursement follows CMS global surgery indicator codes and supplementary indicators (MMM, XXX, YYY, ZZZ) and applies to minor and major procedures with postoperative periods of 0, 10, or 90 days.

Included services

Beginning with the day before surgery for major procedures: preoperative services rendered after the decision for surgery is made to operate.
Beginning with the day of surgery for minor procedures: preoperative services rendered after the decision for surgery is made to operate.
Intraoperative services normally part of the surgical procedure.
E/M services rendered after the decision for surgery has been made.
Miscellaneous surgical services and supplies used during the surgery, including surgical kits, fluid and drug administration services, therapeutic drugs, local anesthetic injections, topical anesthesia, anesthetic blocks or agents, and unspecified/unclassified drug codes administered by the operating provider.
Intraoperative management and devices for pain and related care.
Visits during the postoperative period that are related to recovery from the surgery regardless of place of service.
Moderate sedation provided as part of the surgical package.
Medical or surgical services due to postoperative complications that do not require additional trips to the operating room and that are not categorized as a Hospital-Acquired Condition (HAC) or Present on Admission (POA).
Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline (HCPCS Code S2083).
Postsurgical management by the surgeon and incision and drainage procedures (CPT codes 10060, 10061, 10140, 10160, 10180).

Separately reimbursable services

The initial consultation or evaluation by the surgeon to determine the need for a major surgical procedure.
Services of other physicians except where the surgeon and the other physician(s) agree on transfer of care (agreement must be documented as a letter or annotation in the discharge summary, hospital record, or ASC record).
Treatment for an underlying condition or an added course of treatment that is not part of the normal recovery from surgery.
Visits during the postoperative period that are unrelated to the diagnosis of the surgery, unless the visits occur due to complications of the surgery.
Diagnostic tests and procedures performed during the postoperative period that are not part of the global package.

Billing and modifier rules

Providers must use applicable HIPAA-compliant modifiers for any services provided during the postoperative period.
Transfer of care between physicians requires a written agreement or an annotation in the discharge summary, hospital record, or ASC record to be separately reimbursable.

Global period assignment

Health Plan follows CMS global surgery indicator codes and supplementary indicators MMM, XXX, YYY, and ZZZ; YYY-coded services have payer-determined postoperative day assignments as listed in the policy.

Reimbursement for the global surgical package may be furnished in any setting and applies to both participating and non-participating providers unless contracts indicate otherwise.

Global Surgery Indicators and Postoperative Periods

Global surgery indicator groupsmixed

MMM	Maternity care and delivery procedure codes; 45-day global period (0 postoperative days)
XXX	Codes the global surgery concept does not apply to (0 postoperative days for surgical procedures; 10 postoperative days for anesthesia procedures)
YYY	Codes where Health Plan/MAC determines the global period (0, 10, 45, or 90 days); specific CPT and Category II/T codes listed in policy (examples: 17999, 38589, 40899, 41899, 68899, 0440T, 0441T, 0442T, 0444T, 0647T, 0673T, 0699T, 59898, 15999, 19499, 20999, 21089, 21299, 21499, 21899, 22899, 22999, 23929, 24999, 25999, 26989, 27299, 27599, 27899, 28899, 29999, 30999, 31299, 32999, 33999, 39599, 40799, 41599, 42299, 42699, 42999, 43659, 43999, 44238, 44799, 44899, 44979, 67299, 67599, 67999, 68399, 69399, 69799, 69949, 69979, 0335T, 0345T)
ZZZ	Add-on codes related to another service and always included in the global period of the primary service

Postoperative Periods

Postoperative day categories0 days

Postoperative day categories10 days

Postoperative day categories45 days

Postoperative day categories90 days

Key Definitions

Global Surgical Package — Definition

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

Included components (summary)Preoperative evaluation and preparation, intraoperative services, postoperative visits related to recovery, supplies and drugs related to the procedure.

Billing noteProviders must use applicable HIPAA-compliant modifiers for services provided during the postoperative period and follow transfer-of-care documentation requirements.

Major Procedures (90-day Global)

Major procedures — global period90-day global surgical period (Major procedures are codes assigned a 90-day global period).

Sample YYY 90-day codes15999, 19499, 20999, 21089, 21299, 21499, 21899, 22899, 22999, 23929, 24999

Additional examples25999, 26989, 27299, 27599, 27899, 28899, 29999, 30999, 31299, 32999

Minor Procedures (0-day or 10-day Global)

Minor procedures — global period options0-day or 10-day global surgical period depending on complexity.

XXX indicatorCodes where the global surgery concept does not apply: 0 postoperative days for surgical procedures, 10 postoperative days for anesthesia procedures.

Example YYY 10-day codes17999, 38589, 40899, 41899, 68899, 0440T, 0441T, 0442T, 0444T, 0647T, 0673T, 0699T.

Indicator Categories (MMM / XXX / YYY / ZZZ)

MMMMaternity care and delivery procedure codes; 45-day global period (usual global period does not apply).

XXXCodes to which the global surgery concept does not apply — 0 postoperative days for surgical procedures and 10 postoperative days for anesthesia procedures.

YYYCodes for which the Health Plan/MAC determines the global period; global period may be 0, 10, 45, or 90 days (specific CPT/Codes listed in policy).

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

OpenPayer

Global Surgical Package (Professional) Reimbursement

Global Surgical Package Coverage

Global Surgery Indicators and Postoperative Periods

Authorization, Legal and Billing Actions

Key Definitions