Most Medicare surgical codes are paid as a package: one payment covers the procedure and the routine care before and after it. How long that package lasts is the code's global period, and it is listed for every code in the Medicare Physician Fee Schedule as 000, 010 or 090. This article explains what each period covers, what you can still bill separately, and which modifiers tell Medicare a service falls outside the package.
The three global periods
| Indicator | Type | What it covers |
|---|---|---|
| 000 | Endoscopies and some minor procedures | The day of the procedure only |
| 010 | Other minor procedures | The day of the procedure and the 10 days after (11 days in all) |
| 090 | Major surgery | The day before, the day of the procedure and the 90 days after (92 days in all) |
The count starts the day after the procedure. Minor procedures and endoscopies have no pre-operative day; major surgery has one.
A few codes carry other indicators. XXX means the global concept doesn't apply, which is the case for office visits and most diagnostic tests. ZZZ marks an add-on code that falls within the global period of the primary procedure it is billed with. YYY means the local Medicare contractor (MAC) sets the period.
Some examples from the current fee schedule:
- 27447
- Total knee replacement: 090, major surgery
- 47562
- Laparoscopic cholecystectomy: 090, major surgery
- 69436
- Ear tube insertion under general anesthesia: 010, minor procedure
- 20610
- Large joint injection or aspiration: 000, minor procedure
- 43239
- Upper GI endoscopy with biopsy: 000, endoscopy
You can check the global period of any code, along with the split-care percentages and modifier rules, in our free Medicare fee schedule lookup.
What the package includes
According to CMS, the global payment covers:
- Pre-operative visits after the decision to operate: the day before and the day of major surgery, and the day of a minor procedure
- All the usual parts of the procedure itself
- Follow-up visits during the global period that are related to the surgery
- Treatment of complications that doesn't require a return to the operating room
- Post-surgical pain management by the surgeon
- Routine supplies and services such as dressing changes, removal of sutures, staples, lines, drains and tubes
What you can still bill
These services are outside the package and are paid separately, usually with a modifier:
- The visit where the decision for major surgery is made
- Visits for problems unrelated to the surgery
- Treatment of the underlying condition beyond normal recovery
- Diagnostic tests and procedures, including imaging
- A return to the operating room for a complication
- A distinct, unrelated procedure during the global period
- Critical care unrelated to the surgery
Modifiers for services during a global period
- 57
- The E/M visit, the day before or the day of a 90-day procedure, that resulted in the decision for surgery
- 25
- A significant, separately identifiable E/M on the same day as a minor procedure or another service
- 24
- An unrelated E/M by the same physician during the post-operative period
- 58
- A staged or related procedure: planned in advance, more extensive than the first, or therapy after a diagnostic procedure
- 78
- An unplanned return to the operating room for a related procedure
- 79
- An unrelated procedure by the same physician during the post-operative period
- FT
- Critical care unrelated to the surgery, furnished during the global period
Procedures billed with 58 or 79 start a new global period. Procedures billed with 78 don't; the original global period continues.
Modifier 57 is for major surgery only. For a 0 or 10-day procedure, the evaluation that leads to the decision to do it is part of the procedure payment. A same-day E/M is paid only if it is significant and separately identifiable, billed with modifier 25.
Split care: modifiers 54, 55 and 56
When different practitioners share the care, each bills the same procedure code and date of service with a modifier, and each is paid a share of the total. The shares are set for each code in the fee schedule.
- 54: surgical care only
- 55: post-operative care only. The date of service is the date of surgery, the same as on the surgeon's claim.
- 56: pre-operative care only
Since January 1, 2025, Medicare requires modifier 54 on all 90-day procedures when the surgeon expects to furnish only the surgery, whether or not the transfer of care is formally documented. CMS also created add-on code G0559 for post-operative care furnished by a practitioner who did not perform the procedure and is not in the surgeon's group practice.
Common denials
- A follow-up visit for the surgical condition billed during the global period. Medicare treats it as included and denies it.
- Modifier 57 used on a 0 or 10-day procedure, where it doesn't apply.
- Modifier 57 used on a post-operative visit. It is only for the visit, the day before or the day of a 90-day procedure, where the decision for surgery is made.
- Modifier 25 used on a same-day visit that only covers the usual evaluation before the procedure.
- Modifier 24 used without a diagnosis that shows the visit was unrelated to the surgery.
- A procedure in the global period billed without 58, 78 or 79.
Commercial payers and Medicaid plans often follow Medicare's global periods, but not always. Check the payer's own policy for codes you bill often.
Sources: CMS MLN Global Surgery Booklet (MLN907166), Medicare Claims Processing Manual, Chapter 12, section 40, CMS CY 2025 Physician Fee Schedule final rule fact sheet.
If global period denials are costing your practice, our billing team can review your surgical claims.