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Medicare pays for most surgery as a bundle: one payment covers the procedure itself plus the related care delivered by the same physician or same-specialty group in a fixed window around it. That window is the global period, and its length is assigned per CPT code in the Physician Fee Schedule as one of three indicators — 000 (day of procedure only), 010 (day plus 10 following days, 11 total) or 090 (one preoperative day, the day of surgery and 90 following days, 92 total). The counting rules follow the Medicare Claims Processing Manual, Chapter 12.
Inside the window, related E&M visits are not separately billable; unrelated services can be billed with the correct modifier (24, 25, 57, 58, 78, 79). To look up a code’s indicator, use the CMS Physician Fee Schedule Look-up Tool with all columns shown and read the GLOBAL column.
Per CMS guidance, the bundled payment covers: preoperative visits after the decision to operate (for 090-day codes, the visit the day before surgery), intra-operative services that are a usual part of the procedure, all follow-up visits related to recovery, care for complications that do not require a return to the operating room, post-surgical pain management by the surgeon, and routine supplies. Services unrelated to the procedure remain separately billable throughout.
| Modifier | Use |
|---|---|
| 24 | Unrelated E&M service by the same physician during the postoperative period |
| 25 | Significant, separately identifiable E&M on the day of a procedure |
| 57 | E&M that resulted in the decision for surgery |
| 58 | Staged or related procedure during the postoperative period |
| 78 | Unplanned return to the operating room for a related procedure |
| 79 | Unrelated procedure during the postoperative period |
Documentation must always support the modifier: auditors look for the unrelated diagnosis (24, 79), the separately identifiable service (25), or the return-to-OR note (78) in the record itself.