CurrentUCarePolicy MLN907166

Global Surgery

Defines Medicare-based global surgery package rules for billing and payment across settings, including classification of global periods, included and excluded services, split/shared billing, and relevant modifiers; applies to providers billing Medicare services.

Policy Summary

PayerUCare

PolicyGlobal Surgery

Policy CodePolicy MLN907166

Change TypeNo substantive updates

Effective DateDec 1, 2025

Next Review Date

Key ActionUse modifiers 54, 55, and 56 to document formal transfers of parts of the global surgical package and maintain written transfer agreements when splitting global services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

0,10,90global period options

3global package types

54,55,56,25,57key modifiers referenced

16%assistant-at-surgery payment

92total days for 90-day major

Global Surgery Coverage Rules

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Included and excluded services

Services included in, and excluded from, the global surgical package. Use these rules when determining which services are bundled into the global payment and which may be billed separately.

ALL of the following

ANY of the following
- Pre-operative visits after the decision to operate (for major procedures includes the day before surgery; for minor procedures includes visits on the surgery day).
- Intra-operative services normally part of the surgical procedure.
- Post-operative services the surgeon provides for complications that do not require a return to the operating room.
- Follow-up post-operative recovery visits and post-surgical pain management.
- Routine supplies (except exclusions) and miscellaneous services such as dressing changes, local incision care, removal of operative packs, removal of sutures/staples, removal/insertion/irrigation of catheters and tubes, and tracheostomy tube changes/removals.

ALL of the following

ANY of the following
- The surgeon's first evaluation that results in the decision for major surgery (report with CPT E/M and modifier 57). Modifier 57 is not allowed for minor surgeries. MACs may deny modifier 57 for visits on the day of or day before procedures with 000- or 010-day globals.
- Services by other providers related to the surgery, unless there is a documented transfer of care agreement (letter or annotation in discharge, hospital, or ASC record).
- Visits unrelated to the surgical diagnosis (unless they occur because of surgical complications).
- Treatment for underlying conditions or additional treatment courses not part of normal recovery.
- Diagnostic tests and procedures, including diagnostic radiology, when not part of the bundled services.

ALL of the following

ANY of the following
- 10-day global period (010): Generally no separate post-operative visit payments within 10 days of surgery; diagnostic biopsies with a 10-day global that precede a same-day major surgery may allow separate payment for the major surgery. Minor procedure services by other providers are generally not included in the global fee.
- 0-day global period (000): Post-operative visits beyond the procedure day are not included in the surgery payment and may be billed separately.

Global surgery coverage criteria

Coverage stance and specific billing rules that apply to services related to global surgical packages. Follow these rules to determine when services may be billed separately and which modifiers to append.

ALL of the following

ANY of the following
- E/M services that result in the first decision to do major surgery on the day before or the day of major surgery are not included in the global surgical package and may be billed separately using the appropriate CPT E/M code with modifier 57. Don't use modifier 57 for minor surgeries; MACs may deny E/M services billed with modifier 57 for procedures with 000- or 010-day globals.

ALL of the following

ANY of the following
- When a same-day E/M by the same provider is significant and separately identifiable from the procedure, report the appropriate E/M with modifier 25. Documentation must support medical necessity; documentation is not routinely submitted with the claim but must be available.

ALL of the following

Coding, Modifiers, and Global Periods

Global indicators and related codesmixed

000	Endoscopies/some minor procedures — 0-day post-operative period
010	Other minor procedures — 10-day post-operative period
090	Major surgeries — 90-day post-operative period
YYY	Contractor-priced codes — MACs determine global period (0,10, or 90)
ZZZ	Add-on codes; global period assigned to primary code
G0559	Add-on HCPCS for post-operative care by practitioner other than surgeon

Key modifiers and CPT coding notesmixed

Modifier 57	Decision for surgery — use to identify visit that results in the first decision to do surgery (not for minor surgeries)
Modifier 25	Significant, separately identifiable E/M service by the same provider on the day of procedure
Modifier 24	Unrelated E/M service by the same provider during a post-operative period
Modifier 79	Unrelated procedure or service by the same provider during a post-operative period
Modifier 62	Two surgeons (co-surgeons) — each bills with modifier 62; each paid 62.5% of the global fee
Modifier 66	Surgical team — billed by team surgeons and paid by report
Modifier 78	Unplanned return to the operating or procedure room by the same provider following the first related procedure during the postoperative period
Modifier 58	Staged or related procedure or service by the same provider during the post-operative period (restarts post-operative period)
Modifier 50	Bilateral procedure (when code is not identified as bilateral) — report as a single line item

90-day global total days

90-day global total days92

10-day global total days

10-day global total days11

Post‑operative CPT 99024 reporting threshold

Group size threshold for required CPT 99024 reporting10 or more practitioners in a practice (reporting required in specified states)

Billing Actions and Authorization

Billing Rule

Transfer of care billing actions — Modifiers, documentation, and payment limits

When providers formally or informally split parts of a global surgical package, use the correct modifiers and document the transfer. For formal transfers, providers must keep a written transfer agreement in the patient’s medical record and report the same CPT global surgery code and surgery date on both bills. The combined payments to multiple providers may not exceed what would be paid if a single provider performed all services. Split-global billing does not apply to procedures with a 0‑day post-operative period.

Use the same global surgery CPT procedure code and the date of surgery on both surgical-care and post‑operative-care claims.
Combined payment to multiple providers cannot exceed single‑provider global payment amount except where policy allows.
Maintain a written transfer agreement in the patient’s medical record.

Prior Authorization

Authorization for assistant‑at‑surgery services

Authorization is required before we pay for assistant‑at‑surgery services. Only procedures that were authorized and billed with an assistant‑at‑surgery modifier are payable. Medicare policies on billing above the Medicare‑allowed amount apply; knowingly billing the patient contrary to these rules may result in penalties.

Prior authorization required for assistant‑at‑surgery payment.
Only pay authorized procedures billed with modifiers 80, 81, 82, or AS.
MACs may deny assistant‑at‑surgery payment if a provider acts as an assistant in <5% of cases nationally for that procedure (identified via reviews).

Key Terms and Definitions

Global surgical package (global surgery)

DefinitionAll necessary services normally provided by a provider (or members of the same group with the same specialty) before, during, and after a procedure, paid as a bundled package for most procedures.

ScopeIncludes pre-operative, intra-operative, and post-operative services within the designated global period for most surgical procedures.

Billing implicationProviders in the same group practice and specialty must bill and accept payment as though they are a single physician; global payment generally covers post-operative visits within 10 or 90 days.

Global period classification

Classification typesThree types based on post-operative days: 0-day, 10-day, and 90-day global periods.

0-dayEndoscopies and some minor procedures — no pre-operative period and no post-operative days; procedure-day visit generally not payable separately.

10-dayOther minor procedures — no pre-operative period; total global period is 11 days (surgery day + 10 following days).

90-dayMajor procedures — includes 1-day pre-operative; total global period is 92 days (1 day before, surgery day, + 90 following days).

First E/M Service — Decision to Do Surgery (modifier 57)

PurposeIdentifies the E/M visit that results in the first decision to do surgery and permits separate billing for major surgery when occurring the day before or day of surgery.

ModifierUse CPT E/M code with modifier 57 (Decision for surgery).

LimitationsDo not use modifier 57 for minor surgeries (000 or 010 globals); MACs may deny modifier 57 billed on the day of or day before procedures with 000- or 010-day globals.

Modifier 25 usage

When to useReport when a same‑day E/M is significant and separately identifiable from the procedure performed that day.

ModifierAppend modifier 25 to the appropriate level E/M code on the procedure day.

DocumentationThe physician or qualified NPP must document the medically necessary E/M and procedure in the medical record to support the claim; documentation is not routinely submitted with the claim.

Co-surgeons & Team Surgeons (modifier 62/66)

DefinitionsCo-surgeons: two surgeons (different specialties) performing a procedure; Team surgeons: a team of surgeons (modifier 66) where multiple specialties are required.

BillingEach co-surgeon bills the procedure with modifier 62; team surgeons bill with modifier 66 (paid on a report basis).

Payment shareWhen billing with modifier 62, each co-surgeon receives 62.5% of the global surgery fee schedule amount.

Assistant-at-surgery

Payment percentageFee schedule payment equals 16% of the applicable surgical payment for assistant‑at‑surgery services.

AuthorizationAuthorization is required before payment; only authorized procedures with assistant modifiers (80, 81, 82, AS) are payable.

Denial riskMACs may deny assistant payment if the assistant acts in less than 5% of national cases for that procedure based on reviews.

Critical Care during global surgical period

Reporting conditionsCritical care during a global surgical period may be billed separately if the care is for a critically ill patient and is unrelated to the surgical procedure.

Codes and modifiersReport critical care with CPT codes 99291/99292 and append modifier 25 for pre-operative or modifier 24 for post-operative care.

DocumentationDocument that critical care is unrelated to the surgical procedure and add an ICD-10-CM code demonstrating the unrelated condition; exclude time spent performing specified procedures from critical care time.

Policy Summary

PayerUCare

PolicyGlobal Surgery

Policy CodePolicy MLN907166

Change TypeNo substantive updates

Effective DateDec 1, 2025

Next Review Date

Key ActionUse modifiers 54, 55, and 56 to document formal transfers of parts of the global surgical package and maintain written transfer agreements when splitting global services.

SourceLink

On This Page

Distinct surgical procedures occurring during the post-operative period that are not re-operations or treatment of complications (a new post-operative period starts after such a procedure).

Treatment for post-operative complications that requires a return to the operating room (these are billed separately).

If a less extensive procedure fails and a more extensive procedure is required, the second procedure is separately payable.

Organ transplant immunosuppressive therapy and certain critical care (CPT 99291/99292) unrelated to the surgery (report with modifier FT for unrelated post-operative critical care).

ANY of the following
- Multiple surgeries performed by a single provider or providers in the same group on the same operative session or same day may qualify for separate payment subject to the Medicare multiple procedure payment reduction; distinguish these from incidental or component parts which are not separately billable.

ALL of the following

ANY of the following
- When two surgeons of different specialties each perform the procedure, each bills with modifier 62 and, when allowed, each is paid 62.5% of the global surgery fee schedule amount. Team surgeons bill with modifier 66 and are paid on a report basis. Failure to use required modifier 62 may result in claim denial.

ALL of the following

ANY of the following
- Assistant-at-surgery services require prior authorization before payment; only authorized procedures billed with assistant modifiers (80, 81, 82, AS) are payable. Fee schedule payment equals 16% of the applicable surgical payment. MACs may deny assistant payment when assistant use is unusually rare for a procedure nationally.

ALL of the following

ANY of the following
- Report unrelated procedures during a post-operative period with modifier 79. Report unrelated E/M services during a post-operative period with modifier 24; documentation supporting the unrelated E/M must be available and provided when requested.

ALL of the following

ANY of the following
- When treatment for post-operative complications requires return to the operating room, bill the CPT that describes the return procedure (or an appropriate unspecified code if none exists) and append modifier 78. Do not reuse the original surgery code unless the same procedure is repeated.

ALL of the following

ANY of the following
- Report staged or related procedures during the post-operative period with modifier 58 when the next procedure was planned, more extensive, or therapeutic following a diagnostic procedure; billing modifier 58 restarts the post-operative period for the subsequent procedure.

ALL of the following

ANY of the following
- Critical care (CPT 99291/99292) that is unrelated to the surgical procedure may be billed separately if the patient is critically ill and requires constant provider attendance and documentation shows the care is unrelated to the surgery. Report pre-operative critical care with modifier 25 or post-operative critical care with modifier 24 and include an ICD-10-CM code demonstrating the unrelated condition. Exclude time spent performing certain procedure work from critical care time.

ALL of the following

ANY of the following
- When parts of the global package are provided in different payment jurisdictions, bill the surgical care to the MAC where surgery occurred with modifier 54 and bill post-operative care to the MAC where post-op care occurred with modifier 55.

ALL of the following

ANY of the following
- Global surgery HPSA bonus payments apply when services are provided in an HPSA: bill the global code with the HPSA modifier if the entire package is provided in an HPSA; if only part is provided in an HPSA, use the HPSA modifier for the part provided in the HPSA.

ALL of the following

ANY of the following
- Mohs services are payable only when the Mohs surgeon performs both the surgical and pathology services; billing is not allowed if another provider prepares or interprets the pathology slides.

ALL of the following

ANY of the following
- Do not apply the bilateral payment adjustment to CPT codes already identified as 'bilateral' or 'unilateral or bilateral' in their descriptors. For procedures not so identified, report bilateral procedures with modifier 50 as a single line item (note: this differs from CPT guidance that instructs billing as two line items).