Global Surgery General Information part 1

Definition of a Global Surgical Package

This fact sheet is designed to provide education on the components of a global surgery package. It includes information about billing and payment rules for surgeries, endoscopies, and global surgical packages that are split between two or more physicians. Medicare established a national definition of a global surgical package to ensure that Medicare contractors make payments for the same services consistently across all Medicare contractor (Medicare Administrative Contractor (MAC)) jurisdictions.

This policy helps prevent Medicare payments for services that are more or less comprehensive than
intended. In addition to the global policy, uniform payment policies and claims processing requirements have been established for other surgical issues, including bilateral and multiple surgeries, co-surgeons, and team surgeries. The information that follows describes the components of a global surgical package and billing and payment rules for surgeries, endoscopies, and global surgical packages that are split between two or more physicians.

The global surgical package, also called global surgery, includes all necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for the surgical procedure includes the pre-operative, intra-operative and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician.

Frequently Asked Questions:

Is the global surgery payment restricted to hospital inpatient settings?
Global surgery applies in any setting, including an inpatient hospital, outpatient hospital, Ambulatory
Surgical Center (ASC), and physician’s office. When a surgeon visits a patient in an intensive care or critical care unit, Medicare includes these visits in the global surgical package.

How is Global Surgery classified?
There are three types of global surgical packages based on the number of post-operative days.
Zero Day Post-operative Period , (endoscopies and some minor procedures).
•No pre-operative period
•No post-operative days
•Visit on day of procedure is generally not payable as a separate service

10-day Post-operative Period , (other minor procedures).
•No pre-operative period
•Visit on day of the procedure is generally not payable as a separate service
•Total global period is 11 days. Count the day of the surgery and 10 days following the day of the
surgery 90-day Post-operative Period(major procedures)
•One day pre-operative included
•Day of the procedure is generally not payable as a separate service
•Total global period is 92 days. Count 1 day before the day of the surgery, the day of surgery, and the
90 days immediately following the day of surgery

Where can I find the post-operative periods for covered surgical procedures?
The Medicare Physician Fee Schedule (MPFS) look-up tool provides information on each procedure code, including the global surgery indicator
The payment rules for global surgical  packages apply to procedure codes with global surgery
indicators of 000, 010, 090, and, sometimes, YYY.
•Codes with “000” are endoscopies or some minor surgical procedures (zero day post-operative period).
•Codes with “010” are other minor procedures (10-day post-operative period).
•Codes with “090” are major surgeries (90-day post-operative period).
•Codes with “YYY” are contractor-priced codes, for which contractors determine the global period. The global period for these codes will be 0, 10, or 90 days. Note:not all contractor-priced codes have a “YYY” global surgical indicator. Sometimes the global period is specified as 000, 010, or 090.

While codes with “ZZZ” are surgical codes, they are add-on codes that you must bill with another service.

There is no post-operative work included in the MPFS payment for the “ZZZ” codes. Payment is made for both the primary and the add-on codes, and the global period assigned is applied to the primary code.