CurrentUnitedHealthcarePolicy N/A
Global Surgical Package / Global Periods reimbursement
Defines UnitedHealthcare's reimbursement rules for procedures subject to global surgical packages (global periods), including which services are included or excluded, modifier handling, and applicable provider relationships; applies to UnitedHealthcare Commercial and Individual Exchange plans for services billed on CMS-1500/1500 electronic forms.
Policy Summary
PayerUnitedHealthcare
PolicyGlobal Surgical Package / Global Periods reimbursement
Policy CodePolicy N/A
Change TypeNo material change
Effective DateN/A
Next Review DateN/A
Key ActionAppend the appropriate modifier (e.g., 25, 24, 58, 78, 79, FT) and supporting documentation when billing services that may be separately reimbursable during a global period.
SourceLink
POLICY UPDATE CHANGES
No material clinical or coverage changes in this revision.
000,010,042,090Global Days Values referenced
84%Modifier 78 intraop %
90Major procedure global length
same TINGroup practice rule
Coverage and Reimbursement Criteria
Global Surgical Package inclusion/exclusion criteria
Services performed by the Same Specialty Physician or Other Qualified Health Care Professional (QHP) during the assigned global period are generally included in the Global Surgical Package and are not separately reimbursable unless an exception or appropriate modifier applies.
ALL of the following
- Preoperative visits within the assigned Global Period (day before for Major Procedures with Global Days Value 090; day of for other Global Days Values) are included and not separately reimbursable.
- Complications following a procedure that require additional medical and/or surgical services but do not result in a return to the operating room are included.
- Postoperative visits, including follow-up E/M visits related to recovery occurring within the designated Global Period, are included.
- Post-procedure pain management provided by the Same Specialty Physician or Other QHP is included.
- Selected supplies and miscellaneous routine services related to the procedure (e.g., dressing changes; local incisional care; removal of operative pack; removal of sutures, staples, lines, wires, tubes, drains, casts, splints; insertion/irrigation/removal of urinary catheters; routine IV lines; nasogastric/rectal tubes; tracheostomy tube changes/removal) are included.
- A procedure with a Global Days Value of 000, 010 or 090 performed during the postoperative period of another procedure having a Global Days Value of 010 or 090 and reported by the Same Specialty Physician or Other QHP is considered included in the initial procedure's Global Surgical Package unless an appropriate modifier is appended.
Excluded (may be separately reimbursable when appropriately modified or documented)
- Services of a physician who is not the Same Specialty Physician or Other QHP are not included (see Split Surgical Package policy for transfers of care).
- Initial consultation/evaluation reported with modifier 57 is excluded only for Major Procedures (Global Days Value 090); for procedures with other global values the initial evaluation is included in the procedure allowance.
- Visits unrelated to the diagnosis for which the procedure was performed are excluded when appropriately modified (use modifier 25 for same-day E/M; modifier 24 during the postoperative period).
- Critical care services that are unrelated to the specific anatomic injury or surgical procedure may be separately paid; append modifier FT when critical care is unrelated and the patient meets the definition of critical care.
- Diagnostic tests and procedures (including laboratory and x-rays) are excluded and may be billed separately.
- Staged or related procedures during the postoperative period are not included when reported with modifier 58 (staged/related); clearly distinct unrelated procedures during the postoperative period may be separately reported with modifier 79.
- Treatment for postoperative complications that requires a return to the operating room is reported with modifier 78 and reimbursed according to modifier 78 rules (see modifier 78 guidance).
Group practice / Same-TIN rule: Any physician or other QHP of the same specialty within the same group practice who shares the same Federal Tax Identification Number (TIN) is considered the Same Specialty Physician or Other QHP for purposes of inclusion in the Global Surgical Package (i.e., follow-up care by another same-specialty provider in the same group/TIN is generally included and not separately reimbursable).
Operational note: Providers must append appropriate modifiers and supply supporting documentation when an exception applies (e.g., 25, 24, 57, 58, 78, 79, FT). UnitedHealthcare follows CMS NPFS global day assignments; attachments list full Global Days Value assignments and E/M services included in the Global Period.
Reimbursement criteria for E/M and subsequent procedures during Global Periods
UnitedHealthcare will consider E/M services and subsequent procedures during a Global Period for separate reimbursement only in the circumstances and with the modifier documentation described below.
ALL of the following
- Requirement: Append modifier 25 to the E/M code when a significant, separately identifiable E/M service is rendered on the same day as the procedure. UnitedHealthcare does not require submission of two distinct diagnosis codes to support payment, though all diagnoses present should be listed on the claim.
ALL of the following
- Requirement: Append modifier 24 to the E/M code when the E/M service is unrelated to the procedure and occurs during the postoperative period; the service may be reimbursed separately.
ALL of the following
- Default: Subsequent procedures with Global Days Values of 000, 010 or 090 performed during the postoperative period by a physician of the same specialty and same TIN are considered included in the original procedure and are not separately reimbursable unless an appropriate modifier is reported.
- Exceptions/Modifiers: A subsequent procedure may be considered for separate reimbursement when supported by documentation and appropriately reported with modifier 58 (staged/related), 78 (return to OR for complication — see modifier 78 reimbursement rules), or 79 (unrelated procedure).
ALL of the following
- Requirement: Critical care services that are unrelated to the surgical procedure and meet the definition of critical care may be paid in addition to the procedure when documented as above. When critical care is unrelated, append modifier FT.
Coding, Global Days, and Modifier Rules
Global period code groupmixed
| 000 | Endoscopic or Minor Procedure: preoperative and postoperative relative values on the day of the procedure only; E/M services on the day of the procedure are included in the Global Surgical Package (same-day only). |
| 010 | Minor Procedure: preoperative relative values on the day of the procedure and postoperative relative values during a 10-day postoperative period are included in the Global Surgical Package; E/M services on the day of the procedure and during the 10-day postoperative period are included. |
| 042 | Maternity code assignment (delivery plus postpartum services): assigned Global Days Value of 042; E/M services on the day of delivery and during the 42-day postpartum period are treated per UnitedHealthcare maternity rules. |
| 090 | Major Procedure: includes a 1-day preoperative period and a 90-day postoperative period; E/M services on the day prior to the procedure, the day of the procedure, and during the 90-day postoperative period are included in the Global Surgical Package. |
| MMM | Special maternity grouping referencing values 000, 042, XXX where UnitedHealthcare assigns Global Days Values for maternity-related codes (see attachments). |
| XXX | Placeholder/special value referenced in UnitedHealthcare assignments (see attachments). |
| YYY | Referenced as sometimes assigned in NPFS/global surgery indicators; global period rules may apply for certain codes. |
| ZZZ | Add-on surgical codes: surgical codes that are add-on codes always billed with another service; no postoperative work included in NPFS payment for ZZZ codes — global period assigned to the primary code. |
Global Days assignments (examples)mixed
| Global Days Value = 000 | Global period same day only; includes E/M on that day only (begins and ends the same day). |
| Global Days Value = 010 | Includes E/M on the day of the procedure and during the 10-day postoperative period beginning the first day after the procedure (example: procedure on 10/1 includes E/M on 10/1 and 10/2–10/11). |
| Global Days Value = 042 | Maternity/delivery codes assigned 042: includes E/M on the day of delivery and during the 42-day postpartum period per UnitedHealthcare maternity assignments. |
| Global Days Value = 090 | Includes E/M on the day before, the day of, and during the 90-day postoperative period (example: procedure on 10/1 includes E/M on 9/30, 10/1, and 10/2 through 12/30); total global period counted as 92 days (1 day pre-op + day of surgery + 90 postoperative days). |
inv-05: Modifier 78 intraoperative reimbursement
Modifier 78 intraoperative reimbursement rateWhen modifier 78 is reported for a procedure with Global Days Value 010 or 090, UnitedHealthcare reimburses the intraoperative portion at 84% of the Allowable Amount.
Applies only when Intraoperative Percentage existsThe 84% reduction is applied only if an Intraoperative Percentage is listed in the CMS National Physician Fee Schedule Relative Value File; if no intraoperative percentage is listed, the reduction is not applied (e.g., CPT 77750).
Not applied to other global valuesA modifier 78 reduction will not be applied to procedures with Global Days Values other than 010 or 090, even if modifier 78 is appended.
Effect on global period and multiple procedure rulesA new global period will not be established for a procedure reported with modifier 78 and multiple procedure reductions will not be applied.
inv-06: Postoperative inclusion window
010 Global Days — postoperative windowGlobal Days Value 010 includes E/M services on the day of the procedure and during the 10 days following the procedure, with the postoperative count beginning the first day after the procedure (i.e., procedure on 10/1 includes E/M on 10/1 and 10/2–10/11).
090 Global Days — perioperative windowGlobal Days Value 090 includes E/M services on the day before the procedure, the day of the procedure, and during the 90 days following the procedure (e.g., procedure on 10/1 includes E/M on 9/30, 10/1 and 10/2–12/30).
042 Global Days — referenced behaviorGlobal Days Value 042 includes E/M services on the day of the procedure and during the 42 days following the procedure, with the postoperative count beginning the first day after the procedure.
Inclusion when performed during another procedure's postop periodA procedure with Global Days Value 000, 010, or 090 performed during the postoperative period of another procedure having Global Days Value 010 or 090 is considered included in the initial procedure's global package unless an appropriate modifier is appended.
Provider Billing, Modifiers, and Documentation
Documentation Required
Modifier usage and required documentation to support separate payment
Use the listed modifiers to identify services that are not part of the global surgical package and to document why an E/M or subsequent procedure should be considered separately payable. UnitedHealthcare specifically references modifiers 25, 24, 57, 58, 78, 79 and FT and expects documentation that supports the separate nature of the service when these modifiers are appended.
- Append modifier 25 when a significant, separately identifiable E/M service is rendered on the same day as the procedure.
- Append modifier 24 for E/M services during the postoperative period that are unrelated to the procedure.
- Append modifier 57 when the initial evaluation leads to a major procedure (applies to Global Days Value 090).
- Append modifier 58 for staged or related procedures during the postoperative period.
- Append modifier 78 for return to the OR for treatment of a complication (reimbursement per modifier 78 rules).
- Append modifier 79 for clearly distinct, unrelated procedures during the postoperative period.
- Append modifier FT when critical care services are unrelated to the surgical procedure.
- Document the clinical reason and supporting details (e.g., why the E/M is significant and separate, why care is unrelated or staged) to substantiate separate payment when modifiers are used.
Prior Authorization
Append the appropriate modifier and document clinical rationale
When billing E/M or additional procedure services during a global period, append the specific modifier that matches the circumstance and include documentation that describes why the service is separate from the global package.
- Append modifier 25 to the E/M code when a significant, separately identifiable E/M is performed the same day as the procedure; list all relevant diagnosis codes on the claim as applicable (separate diagnoses are not required).
- Append modifier 24 when an E/M during the postoperative period is unrelated to the procedure.
- Use modifier 57 for the initial evaluation that leads to a Major Procedure (Global Days Value 090) to indicate the evaluation is not included in the procedure allowance.
- Use modifier 58 for staged or related procedures during the postoperative period and modifier 79 for clearly distinct, unrelated procedures.
- Use modifier 78 for procedures that require a return to the operating room for complications; reimbursement follows modifier 78 rules.
- Use modifier FT when critical care visits are unrelated to the procedure and meet critical care criteria.
Definitions and Key Terms
Same Specialty Physician / Other QHP (definition)
DefinitionSame Specialty Physician or Other QHP = physicians and/or other qualified health care professionals of the same group and same specialty reporting the same Federal Tax Identification Number (TIN).
Implication for package inclusionServices provided by another physician/QHP meeting this same‑specialty and same‑TIN definition are considered included in the original procedure’s Global Surgical Package and are generally not separately reimbursable unless an appropriate modifier is appended.
ExampleA cardiologist who performs a procedure and a second cardiologist in the same medical group with the same TIN providing follow‑up during a 10‑day period would not be reimbursed separately for that E/M service.
Allowable Amount (definition)
Allowable Amount — core definitionThe dollar amount eligible for reimbursement to the physician or other QHP on the claim (contracted rate, reasonable charge, or billed charges, as applicable).
Contract/discount considerationFor percent‑of‑charge or discount contracts, the Allowable Amount is the billed amount less the discount.
Role in calculationsAllowable Amount is the base amount used when applying percentage reimbursement rules (for example, the 84% intraoperative reimbursement when modifier 78 applies).
Intraoperative Percentage (definition)
Intraoperative Percentage — purposePercentage for the intraoperative portion of the Global Surgical Package used to calculate reimbursement when modifier 78 is reported.
Interaction with modifier 78When modifier 78 is reported for procedures with Global Days Value 010 or 090 and an Intraoperative Percentage exists, UnitedHealthcare reimburses 84% of the Allowable Amount for the modified procedure.
Absence of percentageIf an Intraoperative Percentage is not listed in the CMS NPFS Relative Value File for the code, the modifier 78 84% reduction will not be applied.
Same Specialty Physician or Other QHP (group practice clarification)
Same Specialty within group practiceAny physician or other QHP of the same specialty within the same group practice sharing the same Federal Tax Identification Number (TIN) is considered the Same Specialty Physician or Other QHP for purposes of the Global Surgical Package.
Coverage effectServices performed by such same‑specialty, same‑TIN providers during the global period are generally included in the global package and not separately payable unless an appropriate modifier is appended and supported by documentation.
Surgeon definition noteUnitedHealthcare defines Surgeon to include the physician who performed the procedure and any physician or non‑physician of the same specialty within the physician’s group practice.
Global Surgical Package / Global Period (definition)
Global Surgical Package / Global Period — core definitionThe time window assigned to a procedure (000, 010, 042, 090) during which specified Evaluation and Management (E/M) services are included in the procedure reimbursement and not separately payable unless exceptions apply.
Examples of values000 = same‑day only; 010/042 = day of procedure plus 10 or 42 days after (postoperative counting begins the day after); 090 = day before, day of, and 90 days after (total 92 days).
ScopeGlobal Surgical Package includes preoperative visits (day before for major procedures), postoperative visits related to recovery, routine supplies and services, and management of certain complications unless return to OR or other exceptions apply.
Policy Summary
PayerUnitedHealthcare
PolicyGlobal Surgical Package / Global Periods reimbursement
Policy CodePolicy N/A
Change TypeNo material change
Effective DateN/A
Next Review DateN/A
Key ActionAppend the appropriate modifier (e.g., 25, 24, 58, 78, 79, FT) and supporting documentation when billing services that may be separately reimbursable during a global period.
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.