ModifiedUCarePolicy N/A

Global Surgery

Defines Medicare's national global surgical package policies — what services are included/excluded, how global periods are classified (0-,10-,90-day), rules for split/shared billing, modifiers, and multiple surgery payment adjustments; affects providers billing Medicare for surgical and related services.

Policy Summary

PayerUCare

PolicyGlobal Surgery

Policy CodePolicy N/A

Change TypeAdded modifiers guidance; new HCPCS add-on code

Effective DateN/A

Next Review DateN/A

Key ActionWhen providers agree on transfer of care, use modifiers -54, -55, or -56 and keep a written transfer agreement in the medical record.

SourceLink

POLICY UPDATE CHANGES

Added information about modifiers (page 9).

Created a new G-code, HCPCS code G0559, for post-operative care services provided by a practitioner other than the one who performed the surgical procedure (or another practitioner in the same group practice).

3global surgery period types (0-, 10-, 90-day)

G0559new HCPCS add-on code

000/010/090global surgery indicators described

16%assistant-at-surgery payment

Services Included, Excluded, and Special Situations

inv-01: Included and Excluded Services

Services included in the global surgical package and services that are excluded (separately billable).

Included services: Pre-operative visits after the decision to operate (for major procedures includes the day-before visit; for minor procedures includes visits on the day of surgery); intra-operative services necessary to the surgical procedure; follow-up post-operative recovery visits; post-surgical pain management; supplies except listed exclusions; and miscellaneous routine services such as dressing changes, incision care, removal of sutures/staples, lines/wires/tubes/drains management, catheter removal, routine peripheral IVs, nasogastric/rectal tubes, and tracheostomy tube changes.

Excluded (separately payable) — examples

Surgeon's first evaluation that results in the decision to do major surgery (report separately with modifier -57; not for minor surgeries).
Other providers' related surgery services unless there is a documented transfer of care agreement (written agreement kept in the medical record).
Visits unrelated to the surgical diagnosis unless they occur because of surgical complications.
Treatment of an underlying condition or an added course of treatment that is not part of normal recovery from the surgery.
Diagnostic tests and diagnostic radiological procedures.
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 a subsequent procedure).
Treatment for post-operative complications that requires return to the operating room (OR) — separately payable; bill the CPT that describes the return procedure or an unspecified procedure code if no specific code exists.
If a less extensive procedure fails and a more extensive procedure is required, the second (more extensive) procedure is separately payable.
Organ transplant immunosuppressive therapy (excluded).
Critical care services (CPT 99291/99292) that are unrelated to the surgical procedure; for unrelated post-operative critical care report modifier -FT.

inv-02: Special Situations

Guidance on minor procedures, 0-/10-day globals, and situations when multiple providers share parts of the global package.

Minor procedures and endoscopies have 10-day (010) or 0-day (000) post‑operative periods. For 10‑day globals, separate post‑operative visits or services related to routine recovery are not payable within 10 days. For 0‑day globals, post‑operative visits beyond the procedure day are separately billable and payable.

If a diagnostic biopsy with a 10‑day global precedes a major surgery on the same day or within the 10 days, Medicare separately pays for the major surgery.

When more than one provider provides services included in the global surgical package (for example when the surgeon cannot provide follow‑up care), the providers may split payments but the total approved payment generally may not exceed what would be paid if a single provider furnished all services. Split global billing does not apply to codes with a 0‑day post‑operative period.

When providers agree to transfer care, they must document the written transfer agreement in the patient's medical record (discharge summary, hospital record, or ASC record).

inv-03: Modifier and E/M Guidance

Rules for modifier use for transfers and for same‑day E/M services by the same provider.

Use modifiers -54 (surgical care only), -55 (post‑operative management only), and -56 (pre‑operative care only) to distinguish parts of the global package when providers formally agree on a transfer of care. Providers must bill the same CPT procedure code and date of service, and keep a copy of the written transfer agreement in the medical record. The provider accepting post‑operative care must provide at least one service before billing with -55. Modifiers -54 and -55 do not apply to assistant‑at‑surgery services or ASC facility fees.

If a transfer of care does not occur, occasional post‑discharge services by another provider should be reported with the appropriate E/M code without claim modifiers. Providers offering minor ED follow‑up services should bill the level E/M code without a modifier.

For CY 2025 Medicare created HCPCS add‑on code G0559 to report post‑operative care services provided by a practitioner other than the one who performed the surgical procedure (or another practitioner in the same group practice).

Use modifier -25 to report a significant, separately identifiable E/M service by the same provider on the day of a procedure. The E/M service must be sufficiently documented in the medical record. Use modifier -24 for unrelated E/M services during a post‑operative period when appropriate.

inv-04: Coverage criteria for global surgery-related payments

Payment, reporting, and modifier rules that allow separate payment or adjusted payment in specific global‑surgery situations.

Co‑surgeons: When two surgeons of different specialties perform the same procedure, each must bill with modifier -62. Each co‑surgeon’s fee schedule payment is 62.5% of the global surgery fee schedule amount. Some procedures explicitly require modifier -62 or claims may be returned unpaid.

Surgical team: When a team of surgeons (more than two surgeons of different specialties) is required, each surgeon bills with modifier -66 and services are paid on a report basis; adequate documentation of team medical necessity is required.

Assistant‑at‑surgery: Assistant services payable only when billed with approved modifiers (-80, -81, -82, -AS). Assistant payment equals 16% of the applicable surgical payment. MACs may deny assistant payment if a provider acts as an assistant in fewer than 5% of national cases for that procedure.

Critical care: Unrelated critical care (CPT 99291/99292) may be separately billed and paid when the patient is critically ill and the critical care is unrelated to the surgical procedure. Report CPT 99291/99292 with modifier -25 for pre‑operative or -24 for post‑operative critical care, and include an ICD‑10‑CM diagnosis documenting the unrelated critical illness. Certain procedures (for example CPT 31500 and 93503) are not bundled into critical care and may be separately payable when criteria are met.

Global Period Indicators, Codes, and Modifiers

Global period indicators and new post-op add-on codeHCPCS | mixed

000/010/090	Medicare global surgery indicators: 000=0-day, 010=10-day, 090=90-day
G0559	HCPCS add-on code for post-operative care services provided by a practitioner other than the one who performed the surgical procedure (CY 2025)

Modifiers referencedModifier

-57	Decision for surgery — use for first E/M service resulting in decision to do major surgery (not for minor surgeries)
-25	Significant, separately identifiable E/M by same provider on day of procedure
-24	Unrelated E/M service by same physician during a post-operative period
-54	Surgical care only (used when transferring part of global package)
-55	Post-operative management only (used by provider accepting post-op care)
-56	Pre-operative care only

Critical care and related codesCPTCovered

99291/99292	Critical care services codes referenced for separate reporting with modifier -25 (pre-op) or -24 (post-op) when unrelated to surgery
31500	Endotracheal intubation — not bundled into critical care
93503	Flow-directed (Swan-Ganz) catheter insertion — not bundled into critical care

Unspecified procedure codes for return to ORCPT

47999	Unspecified procedure code example for return to OR when no specific code exists
64999	Unspecified procedure code example for return to OR when no specific code exists

Global period lengths (days)

0-day global period0 days (Indicator 000) — no pre-operative period; generally no post-operative days; procedure-day visits usually not separately payable.

10-day global period10 post-operative days (Indicator 010) — no pre-operative period; total global period counts surgery day + 10 days (11 days total).

90-day global period90 post-operative days (Indicator 090) — includes 1-day pre-operative; total global period counts 1 day before, surgery day, + 90 days (92 days total).

Billing Actions, Modifiers, and Payment Practices

Documentation Required

Same-provider E/M on procedure day (Modifier -25)

Use modifier -25 (Significant, separately identifiable E/M service by the same provider on the day of procedure) when the patient's condition requires a significant, separately identifiable E/M service beyond the usual pre- or post-operative care associated with the procedure. The E/M must be documented as medically necessary and clearly distinct from the procedure-related care. Documentation should support the level of E/M billed; you do not need to submit the documentation with the claim but must retain it in the medical record.

Report modifier -25 with the appropriate level E/M code on the same date of service as the procedure.
If the E/M is within the post-operative period of another unrelated procedure, use modifier -24 (Unrelated E/M) and modifier -25 as appropriate.
Different diagnosis codes are not required when reporting the E/M on the same date as the procedure, but documentation must show the E/M was significant and separate from the procedure.

Billing Rule

Return to OR and staged procedures (Modifiers -78 and -58)

Use modifier -78 for an unplanned return to the operating or procedure room by the same provider during the global postoperative period when the return is for treatment of complications or when another related procedure during the first postoperative period requires the operating room. Use modifier -58 for staged or related procedures performed by the same provider during the postoperative period when the subsequent procedure was planned prospectively, is more extensive than the original procedure, or is for therapy following a diagnostic surgical procedure. When billing for a return to the OR, report the CPT code that describes the procedure performed during the return trip; do not bill the original procedure code unless you repeat that same procedure.

Modifier -78: Use with the CPT code that describes the unplanned return procedure. If no specific code exists, use an appropriate unspecified code in the correct series (e.g., 47999, 64999).
Modifier -58: Use with the CPT code for the staged or related procedure; a new postoperative period begins when the next procedure in the series is billed.
Do not use the original surgery CPT code for the return trip unless the same procedure is repeated.
Modifier -78 does not limit the types of complications that justify its use; apply based on clinical circumstances.

Key Terms and Modifier Definitions

Global surgical package definition

DefinitionThe global surgical package (global surgery) is the set of services normally provided by a provider (or members of the same group with the same specialty) before, during, and after a procedure.

Group practice billingProviders in the same group practice with the same specialty must bill and accept payment as though they are a single physician.

PurposeEstablishes uniform payment policies and claims processing rules across MAC jurisdictions, including bilateral/multiple surgery and co-surgeon/team billing rules.

Global period indicators

000 (0-day)Identifies endoscopies or some minor surgical procedures with a 0-day post-operative period.

010 (10-day)Identifies other minor procedures with a 10-day post-operative period.

090 (90-day)Identifies major surgeries with a 90-day post-operative period.

YYY / ZZZYYY = contractor-priced codes (MACs set global period as 0, 10, or 90); ZZZ = add-on codes (must bill with primary service; post-op work not included).

Modifier -25 definition

Modifier -25Use to report a significant, separately identifiable E/M service by the same provider on the day of a procedure; require documentation of the medically necessary E/M and procedure in the medical record.

When to useApply -25 with the appropriate level E/M code when the E/M goes beyond usual pre- and post-operative care; do not need different diagnoses on the claim date but must document the service.

Interaction with -24Use -25 and -24 together when a same-day significant E/M falls within the post-operative period of an unrelated procedure.

Modifier -79 definition

Modifier -79Unrelated procedure or service by the same provider during a post-operative period; a new post-operative period starts when billed.

Use caseAppend -79 when the procedure or service is unrelated to the original procedure and occurs during its post-operative period.

EffectWhen billed with -79, a new post-operative period begins for the unrelated procedure.

Modifier -24 definition

Modifier -24Unrelated E/M service by the same provider during a post-operative period; provider must document the unrelated E/M and send supporting documentation if requested.

DocumentationThe E/M service billed with -24 must be documented to support that it is unrelated to the original procedure's post-operative care.

Use with -25Use -24 when an unrelated E/M occurs in a post-op period; -25 may be used for significant same-day E/M as applicable.

Modifier -62 definition

Modifier -62Two surgeons of different specialties performing the same procedure each bill with modifier -62 (co-surgeons).

PaymentWhen billed with -62, the fee schedule amount for each co-surgeon is 62.5% of the global surgery fee schedule amount.

RequirementCo-surgeons must document the medical necessity for certain services in the patient's record; some procedures require -62 or claims are returned unpaid.

Modifier -66 definition

Modifier -66Use for surgical team billing when more than two surgeons of different specialties are required; each team surgeon bills with -66.

Payment basisTeam surgery with modifier -66 is paid on a report basis; documentation must show the team's medical necessity.

When it appliesApplies when a team (more than two different specialty surgeons) performs a procedure; MFSDB Field 25 identifies certain services submitted with -66.

Assistant-at-surgery modifiers and usage

Assistant modifiers list-80 (Assistant surgeon), -81 (Minimum assistant surgeon), -82 (Assistant surgeon when resident not available), -AS (PA/NP/CNS).

PaymentAssistant-at-surgery services are reimbursed at 16% of the applicable surgical payment.

Payment denial riskMACs may deny assistant payment if a provider acts as assistant in less than 5% of national cases for that procedure based on manual review.

Modifier -78 definition

Modifier -78Use to report an unplanned return to the operating or procedure room by the same provider for a related procedure during the post-operative period.

Coding guidanceBill the CPT code that describes the return procedure; if no specific code exists, use an unspecified procedure code in the correct series (e.g., 47999 or 64999).

New post-op periodModifier -78 is for unplanned returns related to the original procedure and does not limit the type of complications treated.

Modifier -58 definition

Modifier -58Use for staged or related procedures or services by the same provider during the post-operative period when the procedure was planned, more extensive, or therapy following diagnostic surgery.

Effect on global periodReporting -58 starts a new post-operative period when the next procedure in the series is billed.

When plannedApply -58 when the subsequent procedure was prospectively planned or was more extensive than the original procedure.

Modifier -50 definition

Modifier -50Report bilateral procedures with modifier -50 as a single line item when the CPT code is not explicitly described as bilateral.

When not to useDo not use -50 when the CPT code descriptor already states 'bilateral' or 'unilateral or bilateral' (payment adjustment not applied).

Difference from CPT guidanceThis Medicare instruction differs from CPT guidelines, which recommend billing bilateral procedures as two line items; Medicare requires a single line item with -50 unless code already indicates bilateral.