Did you waste your time watching some action movies? Here is something of worth for you. A detailed guide on “global surgical package” that will obviously help you grow your practice and reap the perks of large financial benefits.
The global surgical package (often called the “global package” or “global surgery package”) is the set of services a surgeon gets paid for as one bundled amount when they perform a procedure. It groups pre-operative care, the operation itself, and routine post-operative care into one payment.
Knowing about global package is important because it will let you know what you can bill separately and you can bill as bundled. Because, if you bill the wrong way payers may deny you medical claim or your practice may suffer external audits. Furthermore, not only you can stop denials but you can also welcome huge prospects of revenue.
What Is the Global Surgical Package?
The global surgical package bundles services related to a surgery into one payment for the surgeon. That payment covers routine things before, during, and after the operation for a set number of days.
CMS clearly defines the global surgery package and specifies what sits inside the bundle and what sits outside. CMS calls this the national definition for a global surgical package and it standardizes how Medicare pays for most operations.
What the Global Surgical Package Includes
Below are the routine care services the global surgical package includes. Remember, you cannot bill them separately unless a special exception applies
Preoperative visits (after decision to operate)
Visits when the surgeon has already decided to do the procedure usually fall under the global surgical package.
If the visit led to the decision to operate, you might bill it separately with the right modifier (see Modifier 57).
Intraoperative services
The actual operation procedure and everything directly part of it (surgical time, normal anesthesia coordination work done by the surgeon, straightforward supplies). These are always inside the global package.
Postoperative visits (during the global period)
Routine post-operative checks, wound checks, suture removal, drain checks, staple removal, and standard follow-ups fall inside. These are included defined by the global period.
Postoperative pain management (by surgeon)
Routine pain control related to the operation is included if the surgeon manages it during the global period.
Supplies and miscellaneous services
Routine supplies (dressings), suture removal, lines and drains, and routine wound care belong in the package.
Handling complications that do not require return to OR
Management of minor complications (like minor infections treated in clinics) typically falls inside the global period. Only an actual return to the operating room for a separate surgical procedure becomes billable as a new procedure (with the use of the right modifier).
What’s Not Included in the Global Package
These clear rules help you know when you may bill separately. Below are common exclusions from the global surgery period.
Initial evaluation to decide on surgery
The first consultation or E/M visit that evaluates the patient and leads to the decision for surgery can be billed separately if it truly resulted in the decision to operate. Modifier 57 often applies here. But if that E/M happens within the global window and it did not result in the decision for surgery, then it’s usually included.
Services by other providers (unless transfer or allowed)
If another specialty provides care unrelated to the surgery (e.g., a cardiologist), that visit usually bills separately. If a transfer of care occurs, some exceptions apply.
E/M visits unrelated to surgery
When a patient visits for an issue unrelated to the surgical condition during the global period, you can bill separately with modifier 24 (unrelated E/M).
Diagnostic tests / imaging / labs
Tests and imaging to diagnose unrelated issues are billable separately. Routine labs or imaging tied to the routine post-op care are usually bundled, unless the test is not part of routine follow-up.
Unrelated additional procedures
If the patient has a second, unrelated procedure during the global period, you may bill that second procedure separately if it truly is unrelated.
Return to OR for complications (sometimes billed separately)
Returning to the operating room for treatment of a complication usually results in separate billing under modifiers (78 or 79), depending on whether the procedure was related or unrelated.
Critical care / ICU (when unrelated)
If the surgeon provides critical care unrelated to the operation, you can bill critical care CPT codes separately. If the care relates to the surgical condition and is routine post-op management, it may be included.
Medications (especially ongoing meds like immunosuppressants)
Drugs that the surgeon does not normally supply or that are ongoing prescriptions beyond routine postop meds are not part of the package.
Distinct procedures during the global period
When you perform a procedure that is distinct and unrelated, you may bill separately and use a distinct procedure modifier (e.g., Modifier 59 or newer category options). Document why it’s unrelated or distinct.
Preoperative & Postoperative Timing Rules
You must have knowledge about some basic timing rules for preoperative and postoperative procedures.
For example,
Which days count?
The day of surgery counts inside the global period. For major surgery, the day before may also count for preoperative E/M if that E/M is routine. If the E/M caused the decision to operate, consider using Modifier 57.
When is pre-op billing separate?
If the pre-operative E/M occurs before the decision to operate or covers a different problem, you may bill it separately.
When is post-op care separate?
If a postoperative visit addresses an unrelated issue, bill with modifier 24. If a complication requires a return to OR, bill the new procedure with appropriate modifier (78 or 79 depending on relation).
When does the global period end?
It ends after the assigned days (0, 10, or 90). After that, routine post-op visits are billable as normal E/M services.
Global Surgical Package Modifiers
Use global surgical package modifier language to pick up common modifiers and what they do. These modifiers help separate services from the global bundle when appropriate.
Modifier 24: Unrelated E/M during post-op period
Use modifier 24 for unrelated E/M visits in the postoperative window.
Modifier 25: Significant, Separately Identifiable E/M on Same Day
Use modifier 25 when an E/M on the same day as a procedure is above and beyond routine pre/post care. Documentation must prove extra work.
Modifier 57: Decision for Surgery
Use modifier 57 when the E/M resulted in the decision to perform major surgery on the day of or day before surgery. This often makes the E/M billable separate from the global package.
Modifiers 54 / 55 / 56: Split Care (Surgical, Pre, Post)
Use modifier 54 for surgical care only (surgeon performing operation but not postop).
Use modifier 55 for postoperative management only.
Use modifier 56 for preoperative management only.
Modifiers 58 / 79 / 78: Staged, Unrelated, Complication Returns
Use modifier 58 for staged or related procedures during the global period (may start a new global period).
Use modifier 78 for return to OR for related complications during the global period.
Use modifier 79 for unrelated procedures during the global period.
New HCPCS code G0559 (2025 update)
CMS created HCPCS add-on code G0559 for CY2025 to report post-operative care services provided by a practitioner other than the one who performed the surgical procedure or someone in the same group practice. This code recognizes the extra work non-operating practitioners may provide for follow-up care during a 90-day global period. Use this code only in the situations CMS outlines.
In Which Settings Does the Global Package Apply?
The global surgical package applies to services performed in different settings. Here is a detailed overview of multiple settings where global period rules apply.
Hospitals (inpatient):
Many global rules apply. Shared care and split visit rules often reference facility status.
Ambulatory Surgical Centers (ASCs)
Global package applies; documentation and site-of-service coding matter.
Physicians’ offices
Procedures done in office may have different expectations for split/shared billing (Medicare treats some settings differently).
ICU / Critical Care
If critical care services relate to the surgery but are routine post-op, they may be included; if unrelated, bill separately. Always document relation to the surgery.
Check payer rules and CMS guidance for site-specific nuances.