CurrentMolina HealthcarePolicy N/A

Global surgical package reimbursement

Governs Molina Healthcare's reimbursement rules for services included in and excluded from the global surgical package for providers submitting claims; applies to Molina-covered members and treating providers. State exceptions may apply.

Policy Summary

PayerMolina Healthcare

PolicyGlobal surgical package reimbursement

Policy CodePolicy N/A

Change TypeTemplate updateshistorical revisions

Effective DateN/A

Next Review DateN/A

Key ActionUse HIPAA-compliant modifiers with corresponding CPT/HCPCS and appropriate diagnosis codes to avoid denials or audits.

SourceLink

POLICY UPDATE CHANGES

Updated Template on 12/12/2024

Updated Template on 08/08/2025

Initial Creation Date 09/01/2023 (New Policy)

90/10/0 dayspostoperative periods defined for procedures

3policy documentation history entries

1state exceptions section

Global Surgical Package Coverage

Global surgical package coverage criteria

Services included in the global surgical package and those separately reimbursable.

Policy Summary

PayerMolina Healthcare

PolicyGlobal surgical package reimbursement

Policy CodePolicy N/A

Change TypeTemplate updateshistorical revisions

Effective DateN/A

Next Review DateN/A

Key ActionUse HIPAA-compliant modifiers with corresponding CPT/HCPCS and appropriate diagnosis codes to avoid denials or audits.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

ALL of the following

Preoperative services (day before for major procedures; day of for minor procedures).
Intraoperative services that are typically necessary for the surgical procedure.
Treatment of additional medical or surgical services during the postoperative period for surgery-related complications provided they do not require additional operating room visits, are not present on admission, and are not hospital-acquired.
Postsurgical pain management by the surgeon.
Postoperative recovery-related visits.
Miscellaneous surgical services and supplies used during surgery.

ALL of the following

Add-on surgical procedures follow the primary surgical code for determination of the global surgical period (add-on procedures align with the primary code).
Unlisted surgical procedures are reimbursed based on individual claim review and require a written description, office notes, and operative reports for consideration.

ALL of the following

The initial consultation or evaluation by the surgeon to assess the need for major surgery.
Services provided by other physicians unless there is documented agreement for care transfer.
Postoperative visits unrelated to the surgery diagnosis, except for surgery-related complications.
Treatment for underlying conditions or additional courses of treatment beyond normal recovery.
Distinct surgical procedures performed during the postoperative period that are not reoperations or treatment for complications.
Postoperative complications requiring a return to the operating room; if a less extensive procedure fails, a more extensive one is separately payable.

ALL of the following

Providers must use HIPAA-compliant modifiers with corresponding CPT/HCPCS codes and appropriate diagnosis codes for reimbursement.
Claims that fall outside the global surgical package definitions may be denied or subjected to post-payment audits to determine inclusion status.

Coding Guidance and Package Rules

Coding guidance and disclaimermixed

Coding disclaimer: codes listed are for reference only; adherence to CPT and industry coding standards required.

Global package inclusion rules — Preoperative, intraoperative, postoperative care and related services included unless specified exclusion applies.

Scope of included servicesPreoperative (day before for major procedures; day of for minor), intraoperative services, postoperative complication treatment not requiring additional OR, postsurgical pain management, postoperative recovery visits, and miscellaneous surgical supplies are included in the global package unless a specific exclusion applies.

Unlisted proceduresReimbursed based on individual claim review and require written description, office notes, and operative reports for consideration.

Add-on proceduresAdd-on procedures align with the primary surgical code for determining the global surgical period.

Claim Submission & Documentation Requirements

Documentation Required

Unlisted Procedures: Documentation Required

Unlisted surgical procedures billed within the global surgical package require complete clinical documentation to be considered for reimbursement. Submit a written description of the procedure, relevant office notes, and the operative report with the claim. Lack of these documents may result in denial or delay.

Provide a clear, written description of the unlisted procedure.
Attach office notes and the operative report that justify medical necessity and detail the procedure performed.
Include relevant diagnosis codes that support the service as separate from the global package.

Billing Rule

Add-on Procedures: Link to Primary Procedure

Add-on procedures are adjudicated in relation to the primary procedure. When billing add-on codes, ensure documentation links the add-on service to the primary procedure and that the add-on is not already included in the global surgical package for the primary code. Claims outside the global package or lacking proper linkage may be denied or placed under audit.

Bill add-on procedures only in conjunction with the appropriate primary procedure code.
Document how the add-on procedure is distinct from services included in the primary procedure’s global period.
Use supporting operative notes and diagnosis codes to show separate, payable work.

Key Definitions

CMS — The Centers for Medicare & Medicaid Services

Agency definitionThe Centers for Medicare & Medicaid Services (CMS) is a federal agency within the U.S. Department of Health and Human Services that administers Medicare and partners with states to administer Medicaid, CHIP, and health insurance portability standards.

Relationship to state programsCMS works in partnership with state governments to administer Medicaid and the Children’s Health Insurance Program (CHIP).

Role in policy hierarchyFederal CMS guidance supersedes this policy where conflicts exist between this policy and federal/state/CMS guidelines or member benefit plans.

Minor Procedures

DefinitionMinor Procedures: surgery involving minor risk to life; operations on superficial structures or manipulative procedures that do not involve serious risk.

Typical examplesProcedures limited to superficial structures or simple manipulative interventions (as described in CMS definition).

Global period implicationMinor procedures use the day-of-service preoperative definition in the global surgical package.

Intraoperative services

DefinitionIntraoperative services: patient care during an operation that is ancillary to the operation, including monitoring vital signs, blood oxygenation, fluid therapy, medication transfusion, anesthesia, radiography, and specimen retrieval for lab tests.

Inclusion in global packageIntraoperative services that are typically necessary for the surgical procedure are included in the global surgical package.

Examples of activitiesMonitoring vitals, anesthesia management, radiography, and retrieving samples during the operation.