- Los Angeles
- San Diego
- San Joaquin
The global surgical package includes all necessary services normally provided by the surgeon before, during and after the surgical procedure. The global surgical package applies to minor procedures that have a 0 or 10-day post-operative period and major procedures that have a 90-day post-operative period as defined by the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule. It also applies to obstetrical procedures that have a 42-day post-operative period.
The global surgical package policy applies to all places of service.
Services Included in the Global Package
The following services are included in the global surgical package and, therefore, are not eligible for separate payment.
- Preoperative evaluation and management (E&M) services that are performed one day prior to major surgery or on the same day as a minor or major procedure
- Exception: New member visits (CPT codes 99201-99205) on the same day as a minor surgery are not included in the global package
- Intraoperative services that are a usual and necessary part of the surgical procedure
- Anesthesia provided by the surgeon
- All additional medical or surgical services required of the surgeon during the post-operative period because of complications, which do not require additional trips to the operating room
- Post-operative E&M services that are related to the surgery
- Post-operative pain management by the surgeon
- Dressing changes, local incision care, removal of operative packs, removal of cutaneous sutures, staples, lines, wires, tubes, drains, and splints, insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes and change and removal of tracheostomy tubes
Services Not Included in the Global Surgery Package
The following services are not included in the global surgical package and, therefore, are eligible for separate payment.
- E&M service that was significant and separately identifiable from the minor surgical procedure performed on the same day. Modifier -25 should be added to the E&M code
- E&M service performed the day prior to or on the same day of surgery resulting in the decision for a major surgical procedure. Modifier -57 should be added to the E&M code
- E&M services that occur during the post-operative period that are unrelated to the surgery. Modifier -24 should be added to the E&M code
- Critical care when billed for serious injuries or burns
- Services of other physicians not in the same participating physician group (PPG) of the physician that performed the surgery, except where a formal transfer of care occurs
- Diagnostic tests and procedures, including diagnostic radiological procedures
- Clearly distinct surgical procedures during the post-operative period that are not re-operations or treatment for complications. Modifiers -58 (staged procedure) or -79 (unrelated procedure or service performed by a physician during the post-operative period) should be added to the surgical procedure code
- Treatment of post-operative complications that require a trip to the operating room. Modifier -78 should be added to the surgical procedure code
- Immunosuppressive therapy for organ transplants. Modifier -24 should be added to the E&M code
NOTE: An E&M service that was significant and separately identifiable from the minor surgical procedure performed on the same day that falls within a global period of a previous service but is not related to the previous service requires both a modifier -25 and a modifier -24.
Health Net does not require documentation at the time of claim submission; however, in the event the claim is audited, documentation may be required.
- CMS National Policy