§ 9789.16.1 Surgery - Global Fee

Summary

Surgical procedures are assigned a global period of zero, 10, or 90 days. The global period for each procedure is specified in the 2014 Medicare National Physician Fee Schedule Relative Value File, column O entitled "Glob Days".

Codes with 000 in the Global Days column are minor procedures or endoscopies with a zero day global period and the global fee covers only services provided on the day of the procedure. Evaluation and Management (E&M) services on the day of the procedure are generally not payable.

Codes with 010 in the Global Days column are minor procedures or endoscopies that have a 10 day global period, meaning that services on the day of the procedure and during the following 10-day period are included in the global fee. E&M services on the day of the procedure are generally not payable.

Codes with 090 in Global Days column are major surgeries with a 90-day global period. Services the day before the procedure, the day of the procedure, and during the following 90 days are included in the global surgery fee.*

The table below summarizes the pre- and post-operative global days.

Global Days Calculation Table

What is payable in the global period, besides certain E&M services?

In addition to E&M services being payable in the Global Period, the Physician Fee Schedule allows for payment of additional services. The list of these services can be found in Section 9789.16.1 on page 30 of the regulations.

Note: Services such as radiology and other diagnostic tests are not part of the global period.

Services Not Included in the Global Surgical Package. The services listed below may be paid for separately:

(A) The initial evaluation of the problem by the surgeon to determine the need for a major surgical procedure. (The initial evaluation is always included in the allowance for a minor surgical procedure and is not separately payable);

(B) Services of other physicians except where the surgeon and the other physician(s) agree on the transfer of care; this agreement may be in the form of a letter or an annotation in the discharge summary, hospital record, or ASC record;

(C) Visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur due to complications of the surgery;

(D) Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery;

(E) Diagnostic tests and procedures, including diagnostic radiological procedures;

(F) Clearly distinct surgical procedures during the postoperative period which are not re-operations or treatment for complications. (A new postoperative period begins with the subsequent procedure.) This includes procedures done in two or more parts for which the decision to stage the procedure is made prospectively or at the time of the first procedure. Examples of this are procedures to diagnose and treat epilepsy (codes 61533, 61534-61536, 61539, 61541, and 61543) which may be performed in succession within 90 days of each other;

(G) Treatment for postoperative complications which requires a return trip to the operating room (OR);

(H) If a less extensive procedure fails, and a more extensive procedure is required, the second procedure is payable separately;

(I) Splints and casting supplies are payable separately;

(J) Immunosuppressive therapy for organ transplants; and

(K) Critical care services (codes 99291 and 99292) unrelated to the surgery where a seriously injured or burned patient is critically ill and requires constant attendance of the physician.

(L) Services that fall within section 9789.16.4 (Primary Treating Physician's Progress Reports, and specified Evaluation and Management visits.)

California Code of Regulations (CCR)

§ 9789.16.1 Surgery - Global Fee

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