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    v1.0.31
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyRegence Global Surgical Package Update | OpenPayer
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    CurrentRegencePolicy Adm 101

    Components of a Global Surgical Package

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    Governs which professional services, supplies, procedures, and evaluation and management services are included in or separately reimbursable from a surgical procedure's global payment for Commercial and Medicare Advantage members.

    Policy Summary
    PayerRegence
    PolicyComponents of a Global Surgical Package
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateJan 1, 202748d
    Last ReviewSep 1, 2026
    Next Review DateN/A
    Key ActionUse the current-year CMS National Physician Fee Schedule Relative Value File to determine the applicable global period.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    0, 10, 90, XXXCMS global-period indicators addressed
    24 hoursGlobal period after a 0-day procedure
    8Modifiers for potential separate reimbursement
    Not reimbursableRelated services within global period
    Once

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    One-or-more-sessions limit

    Global Surgical Package Coverage

    Services included in the global surgical package

    Related services and supplies are included in the surgical global payment and are not separately reimbursable when provided during the applicable global period.

    ALL of the following

    • Related preoperative evaluation and management services are included: services on the day of a minor procedure, and services on the day before and the day of a major procedure.

      Preventive and preventive-like visits billed on the same day as a 0-day minor procedure are not separately reimbursed unless unrelated and separately identifiable.

    • Normal, usual, and necessary intraoperative services are included, including preparation, positioning, access, catheterization, physician-administered sedation or anesthesia, the surgical approach, cultures, irrigation, drains, closure, dressings, documentation, and surgical supplies, subject to applicable CMS exceptions for separate payment.
    • Related professional services provided during the postoperative period are included, including dressing changes, related evaluation and management services, incisional care, surgeon-provided pain management, and removal of staples, tubes, drains, lines, wires, casts, splints, and sutures.
    • Related postoperative care or treatment, including related complications, is included when it does not require a return trip to the operating room.
    • Removal of sutures is not separately reimbursable regardless of the surgical global period.
    • A procedure or service performed solely to confirm the success of the initial procedure or to exclude a complication of that procedure is not separately reimbursable when performed during the global period.
    • Treatment of surgical complications related to preventable adverse events is not separately reimbursable, regardless of the modifier used.
    • The global-package rules apply across places of service, including physician offices, hospitals, and ambulatory surgery centers.

    Services potentially eligible for separate reimbursement

    A service may be eligible for separate reimbursement when it meets one of the qualifying circumstances below and is appropriately documented and reported with the applicable modifier.

    ONE of

    • An evaluation and management service provided the day before or the day of a major surgical procedure is for the initial decision to perform the surgery.

      Append modifier 57.

    • An evaluation and management service provided on the same day as a minor procedure is unrelated to the procedure, significant, and separately identifiable.

      Append modifier 25.

    • An evaluation and management visit during the postoperative period is unrelated to the surgical procedure.

      Append modifier 24.

    • A repeat surgical procedure by the same surgeon is performed on the same day as the original surgery and requires a return trip to the operating room.

    Global Periods and Billing Codes

    CMS Global-Period IndicatorsCPT
    000Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.
    010Minor procedure with preoperative relative values on the day of the procedure and postoperative relative values during a 10-day postoperative period included in the fee schedule amount; evaluation and management services on the day of the procedure and during the 10-day postoperative period generally not payable.
    090Major surgery with a 1-day preoperative period and 90-day postoperative period included in the fee schedule amount.
    XXXThe global concept does not apply to the code.
    YYYThe carrier is to determine whether the global concept applies and establishes a postoperative period, if appropriate, at the time of pricing.
    ZZZThe code is related to another service and is always included in the global period of the other service.
    Modifiers Supporting Potential Separate ReimbursementModifierCovered
    Modifier 24Unrelated E&M service during the postoperative period.
    Modifier 25Significant, separately identifiable E&M service on the same day as a procedure.
    Modifier 57Decision for surgery.
    Modifier 58Staged procedure during the postoperative period.
    Modifier 76Repeat procedure by the same surgeon on the same day requiring a return trip to the operating room.
    Modifier 77Repeat procedure by a different surgeon on the same day requiring a return trip to the operating room.
    Modifier 78Unplanned return to the operating room for a related procedure during the postoperative period.
    Modifier 79Unrelated procedure during the postoperative period.
    Preventive and Preventive-Like Services Billed With Minor SurgeryCPTNot Covered
    99391-99397Preventive visits listed in the policy as not separately reimbursable when billed the same day as a 0-day minor surgical procedure unless unrelated and separately identifiable.
    G0402Preventive visit code listed in the policy.
    G0438Preventive visit code listed in the policy.
    G0439Preventive visit code listed in the policy.
    G0513Preventive service code listed in the policy.
    G0514Preventive service code listed in the policy.
    S0285Preventive service code listed in the policy.
    S0612Preventive service code listed in the policy.
    S0621Preventive service code listed in the policy.
    Minor procedure postoperative period
    Procedure typeMinor procedure
    Postoperative period0 or 10 days
    Included servicesRelated postoperative services are included during the applicable period
    Major surgery preoperative period
    Procedure typeMajor surgical procedure
    Preoperative period1 day
    Included services

    Provider Billing and Reimbursement Actions

    Billing Rule

    Determine the applicable global period

    Use the current-year CMS National Physician Fee Schedule Relative Value File to determine the applicable global period. Regence may establish a global period for codes without a CMS-established global period when CMS has not indicated that a global period is inappropriate.

    Billing Rule

    Apply comparable-code global periods

    For unlisted codes or codes without a CMS-established relative value, use the global period of the most closely comparable CPT code for which an allowance is determined.

    Billing Rule

    Apply the longest global period

    Global Period Terminology

    Global period
    TermGlobal period
    DefinitionThe timeframe surrounding a surgical procedure during which related services are bundled into the payment for the procedure
    Non-surgical servicesFor non-surgical procedures or services, related follow-up care is included in the initial payment during the global period
    Major surgical procedure
    TermMajor surgical procedure
    DefinitionA surgical procedure with a 1-day preoperative period and 90-day postoperative period
    Global-period classification
    Policy Summary
    PayerRegence
    PolicyComponents of a Global Surgical Package
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateJan 1, 202748d
    Last ReviewSep 1, 2026
    Next Review DateN/A
    Key ActionUse the current-year CMS National Physician Fee Schedule Relative Value File to determine the applicable global period.
    SourceLink
    On This Page
    Global Surgical Package CoverageGlobal Periods and Billing CodesProvider Billing and Reimbursement ActionsGlobal Period Terminology

    Append modifier 76.

  1. A repeat surgical procedure by a different surgeon is performed on the same day as the original surgery and requires a return trip to the operating room.

    Append modifier 77.

  2. A procedure or treatment related to the original surgery requires an unplanned return to the operating room.

    Append modifier 78.

  3. A procedure or service is unrelated to the original surgery and is performed during the postoperative period.

    Append modifier 79.

  4. A staged surgical procedure that was planned at the time of the original surgery is performed during the original procedure's postoperative period.

    Append modifier 58.

  5. For a non-surgical service that already includes payment for evaluation and management, the evaluation and management service is unrelated, significant, and separately identifiable.

    Separate reimbursement is generally not allowed; modifier 25 may support consideration when the criteria are met.

  6. For a procedure with a CMS XXX global period, the evaluation and management service is significant and separately identifiable.

    The procedure includes inherent pre-, intra-, and post-procedure work; append modifier 25 for reimbursement consideration.

    7. Related preoperative services are included during the applicable period
    Major surgery postoperative period
    Procedure typeMajor surgical procedure
    Postoperative period90 days
    Included servicesRelated postoperative services are included during the applicable period
    CMS 0-day procedure global period
    Procedure typeCMS-assigned 0-day postoperative procedure
    Global periodFirst 24 postoperative hours
    Payment inclusionThe surgical procedure reimbursement includes this global period
    One-or-more-sessions reimbursement frequency
    Applicable codeCPT code with a descriptor containing ‘one or more sessions’
    Reimbursement frequencyOnce within the code's own global period
    Session countThe limit applies regardless of the number of sessions necessary to complete treatment

    When multiple procedures are performed during the same operative session, apply the global period of the procedure with the longer global period.

    Denial Risk

    Do not bypass global-package denials

    Do not separately bill related services and supplies provided during the global period. Appending a modifier does not bypass the resulting denial, and the rule applies in all places of service, including physician offices, hospitals, and ASCs.

    Billing Rule

    Apply covering-provider rules

    Apply the same global-period rules to providers in the same provider group with the same or similar specialty when one provider covers for another.

    Denial Risk

    Account for preoperative anesthesia denials

    Preoperative denials apply to anesthesia services. Account for these denials when reporting anesthesia in connection with a surgical procedure.

    Denial Risk

    Account for postoperative anesthesia denials

    Postoperative denials apply to anesthesia codes one day after the anesthetic was provided.

    Denial Risk

    Do not bill confirmation or exclusion services separately

    Do not separately reimburse a procedure or service performed within the global period solely to confirm the success of, or exclude a complication of, the initial procedure.

    Denial Risk

    Preventable adverse-event complications are not separately reimbursable

    Treatment of surgical complications related to preventable adverse events is not separately reimbursable, regardless of the modifier used.

    Billing Rule

    Report decision-for-surgery E&M

    Append modifier 57 to an E&M code provided the day before or the day of a major surgical procedure when the initial decision to perform surgery was made during that visit.

    Billing Rule

    Report unrelated same-day E&M

    Append modifier 25 when an E&M service on the same day as a minor procedure is unrelated to the procedure, significant, and separately identifiable.

    Billing Rule

    Report unrelated postoperative E&M

    Append modifier 24 when an E&M visit during the postoperative period is unrelated to the surgical procedure.

    Billing Rule

    Identify separately reimbursable surgical circumstances

    Use the applicable modifier to identify a qualifying repeat, staged, unrelated, or return-to-operating-room procedure during the relevant global period.

    • Modifier 76: repeat procedure by the same surgeon on the same day requiring a return trip to the operating room.
    • Modifier 77: repeat procedure by a different surgeon on the same day requiring a return trip to the operating room.
    • Modifier 78: unplanned return to the operating room for a related procedure during the postoperative period.
    • Modifier 79: unrelated procedure during the postoperative period.
    • Modifier 58: planned staged procedure during the postoperative period.
    Billing Rule

    Report separately identifiable non-surgical E&M

    For non-surgical services that already include payment for E&M, separate E&M reimbursement is generally not allowed. Modifier 25 may allow consideration when the E&M service is unrelated, significant, and separately identifiable.

    Denial Risk

    Apply XXX global-period rules

    For codes with a CMS XXX global period, do not separately reimburse E&M services because the procedure includes inherent pre-procedure, intra-procedure, and post-procedure work. Modifier 25 may support reimbursement consideration only when the E&M service is significant and separately identifiable.

    Denial Risk

    Limit one-or-more-sessions codes

    Reimburse a code with a descriptor containing “one or more sessions” only once within its own global period, regardless of the number of sessions required and regardless of the modifier appended.

    The 1-day preoperative and 90-day postoperative periods are included in the procedure payment
    Minor procedure
    TermMinor procedure
    DefinitionA surgical procedure with a 0- or 10-day postoperative period
    Global-period classificationThe applicable postoperative period is either 0 days or 10 days
    Preoperative evaluation and management
    TermPreoperative evaluation and management
    DefinitionAn E&M code provided on the day of or the day before a surgical procedure
    TimingThe service may occur on the procedure date or the preceding day
    Postoperative E&M denial
    TermPostoperative E&M denial
    DefinitionDenial of an E&M code provided during the global period of the surgical procedure
    Applicable serviceThe denial applies to E&M services furnished during the procedure's global period
    Same-day E&M denial
    TermSame-day E&M denial
    DefinitionDenial of an E&M code provided on the same day as a surgical procedure or service with a CMS global period of 0, 10, 90, or XXX days
    Regence-established periodThe denial also applies when Regence establishes a global period for a qualifying code