According to the Centers for Medicare & Medicaid Services, the global surgical package “includes all necessary services normally provided by a provider before, during, and after a procedure.” This bundled payment approach directly determines which services are reimbursable separately or not.
At MedCare MSO, we’ve seen firsthand how misunderstanding the global period in medical billing costs practices thousands in denied claims and lost revenue. Such billing errors result in denials, compliance issues, and revenue loss that most practices hardly recover from. In this guide, we break down everything you need to know about global periods, recent regulatory updates, and practical steps to maximize reimbursement.
The global period represents a specific timeframe surrounding a surgical procedure during which all routine, related services are bundled into one payment. This means insurance companies won’t reimburse separately for standard follow-up visits or typical post-operative care within this window.
2025 CMS regulatory changes have expanded Modifier -54 requirements and introduced new HCPCS code G0559 for post-operative care by non-operating providers (effective January 1, 2025). These updates affect how practices bill 90-day global procedures and require closer attention to documentation, especially when post-operative care involves multiple providers or different practice groups.
The Medicare global period serves as the standard that most private insurers follow. Understanding the insurance global period guidelines prevents billing errors across all payers, not just Medicare.
This is the shortest timeframe, covering only the day of the procedure itself. There’s no pre-operative period included, and any follow-up care beyond the same day can be billed separately.
The 0-day post-operative period applies to endoscopies and some minor procedures, with no pre-operative period and no post-operative days, where generally a visit on the procedure day isn’t payable as a separate service.
Common examples include:
The 10-day post-operative period covers other minor procedures with no pre-operative period, where generally a visit on the procedure day isn’t payable as a separate service, and the total global period is 11 days, counting the surgery day and the 10 days following.
Yes, you read that correctly, it’s actually 11 days total. The procedure day counts as day zero, followed by 10 additional days. Miscalculating this global time period in medical billing is one of the most frequent mistakes we see, which leads to denied claims.
Common examples include:
This is for major surgical procedures and represents the most comprehensive package. The 90-day post-operative period includes 1-day pre-operative care, where generally the procedure day isn’t separately payable, and the total global period is 92 days, counting 1 day before surgery, the day of surgery, and the 90 days following the surgery day.
Again, the actual count is 92 days: one day before the procedure, the day of the procedure, and 90 days after.
Common examples include:
Knowing what’s bundled into the global surgical payment prevents claim denials and coding errors.
Medicare includes pre-operative visits after the decision to operate, intraoperative services, which are normally a necessary part of a surgical procedure, all other medical or surgical services the surgeon provides during the post-operative period, follow-up post-operative recovery period visits, and post-surgical patient pain management. The payment also covers necessary supplies.
The global package covers three main phases:
| Pre-Operative Care | Intraoperative Services | Post-Operative Care |
|---|---|---|
| Visits after the decision to operate (day before for major procedures, same day for minor) | The surgical procedure itself | All routine follow-up visits during the global period |
| Pre-surgical patient evaluation | Local or regional anesthesia administered by the surgeon | Wound care, dressing changes, and suture removal |
| Obtaining informed consent | Surgical supplies and equipment | Pain management and minor complication treatment |
Not everything falls under the global package. We help practices identify these separately billable services to maximize legitimate reimbursement while avoiding global period denial in medical billing:
The surgeon’s first evaluation to find the need for major surgeries can be billed separately using modifier -57, and only for major surgical procedures. This is the E/M visit where you determine that surgery is necessary.
Treatment for post-operative complications when the patient returns to the operating room is separately billable, where an OR is a place of service specifically equipped and staffed solely for doing procedures.
Critical care services for a critically ill, seriously injured, or burned patient during a global surgical period are separately billable if the patient is critically ill and requires constant provider attendance, and the critical care is typically unrelated to the specific anatomic injury or general surgical procedure.
Modifiers tell the insurance company why a service performed during a global period should be paid separately. Using the wrong modifier, or forgetting one entirely, is one of the fastest ways to trigger a denial. Here’s what you need to avoid denials:
| Modifier | When to Use It | Real-World Example |
|---|---|---|
| 24 – Unrelated E/M | E/M visit for unrelated condition during post-op period | Shoulder surgery patient returns with UTI. Bill E/M with Modifier 24. |
| 25 – Significant E/M | Significant E/M same day as minor procedure | Patient evaluated for chest pain; skin tag removed. Use Modifier 25. |
| 54 – Surgical Care Only | Surgeon performs surgery but won't provide post-op care | Surgeon does knee replacement; PCP handles follow-ups. Use Modifier 54. |
| 55 – Post-Op Only | Providing post-op care for another surgeon's procedure | Local MD assumes post-op care after distant hospital surgery. |
| 56 – Pre-Op Only | Providing only pre-op care with formal transfer | ED physician evaluates patient, transfers to surgeon. Use Modifier 56. |
| 57 – Decision for Surgery | E/M results in decision for major surgery (90-day global) | ED visit for appendicitis leads to same-day surgery. Use Modifier 57. |
| 58 – Staged Procedure | Planned procedure during post-op period of original surgery | Biopsy reveals cancer; mastectomy done 2 weeks later. Use Modifier 58. |
| 78 – Return to OR | Unplanned return to OR for complication treatment | Post-op bleeding requires emergency return to OR. Use Modifier 78. |
| 79 – Unrelated Procedure | Unrelated surgery during another procedure's global period | Hip replacement patient needs appendectomy. Use Modifier 79. |
Global period denial in medical billing is one of the most preventable yet costly mistakes practices face. At MedCare MSO, we analyze denial patterns across hundreds of practices, and the same errors appear repeatedly. Understanding these mistakes and how to avoid them can save your practice thousands of dollars monthly.
Here are the five most expensive global period billing errors we encounter:
This is the number one mistake. Practices bill for post-operative visits that are clearly part of the global package, resulting in immediate denials.
Poor communication between clinical and billing staff about which visits fall within the global period, or a lack of awareness about what the global surgery period includes.
Before billing any post-operative visit, verify the original surgery date and global period. Use your practice management system to flag patients currently in a global period.
Billing services during a global period without the appropriate modifier tells the insurance company you’re trying to bill for something already paid.
Providers document unrelated services, but billing staff don’t realize a modifier is needed, or coders don’t understand which modifier applies to which situation.
Create a mandatory checklist for any service provided during a global period. If the service is unrelated or meets exception criteria, the appropriate modifier must be added before the claim goes out.
Assuming you know the global period in medical billing without proper checking leads to errors, some procedures you’d expect to be 10-day are actually 90-day, and vice versa.
Relying on memory or outdated information instead of checking current Medicare fee schedules for each procedure.
Make the Medicare Physician Fee Schedule lookup a required step in your billing workflow. It takes 30 seconds and prevents costly mistakes.
Even with the correct modifier, claims get denied when documentation doesn’t support the billing decision.
Providers don’t clearly indicate why a service during a global period was unrelated or medically necessary, or they fail to document transfer of care arrangements.
Train providers to document specifically. Instead of “patient seen for follow-up,” document “patient seen for unrelated condition: new-onset diabetes management, separate from post-operative knee replacement care.”
The new HCPCS code G0559 has specific rules, and we’re already seeing practices use it incorrectly.
Confusion about when G0559 applies versus when to use Modifier -55, or billing it for providers within the same group practice.
Remember that G0559 must be reported separately in addition to an office or outpatient E/M service and may only be reported once during the 90-day global period. Use it only for providers outside the surgeon’s practice group.
Let’s walk through three common situations to show you exactly how to handle them:
| Scenario | What Happened | Correct Billing Approach | Why This Works |
|---|---|---|---|
| Routine Follow-Up | Patient had knee replacement 3 weeks ago. Returns for routine wound check and suture removal. | Do not bill separately. Services included in 90-day global period. | These are expected post-op services bundled in original surgical payment. |
| Unrelated Condition | Patient had knee replacement 3 weeks ago. Returns with new-onset diabetes symptoms and elevated blood sugar. | Bill E/M with Modifier 24. Document diabetes as separate diagnosis. | Diabetes is unrelated to knee surgery. Modifier 24 signals this is separately payable. |
| Using G0559 | Patient had surgery by Surgeon A at Hospital X. Patient sees PCP at different practice for post-op visit. No formal transfer of care. | PCP bills appropriate E/M code + G0559. Documents review of surgical notes and assessment. | PCP is outside surgeon's practice group, no formal transfer exists, care is within 90-day global. G0559 applies. |
Understanding the global period in medical billing is essential for protecting your practice’s revenue and maintaining compliance. From knowing what the global surgery period includes to applying the correct modifiers and avoiding common mistakes, each element plays a critical role in preventing denials.
When you understand the rules, you handle what many see as a compliance burden. The key is building these practices into your daily workflow rather than treating them as exceptions. Because the investment you make today in training your team and refining your processes will pay dividends for years to come.
By outsourcing your billing services to us, you can expect revenue growth of up to 20%
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