Medicare Advantage Medical Policy Bulletin

Section: Surgery
Number: S-99
Topic: Global Surgery
Effective Date: June 1, 2006
Issued Date: August 18, 2008

General Policy

For services on or after December 17, 2007, see policy N-99. 

Certain services are paid for under what are known as “global fees.” These fees incorporate the reimbursement for services performed at different times by the same provider (or group), but all in conjunction with one medical procedure or episode of care.

Indications and Limitations of Coverage

A standard package of preoperative, intraoperative and postoperative services are included in the payment for a surgical procedure. 

All surgical procedures are classified as one of the following:

Procedures identified as major surgery have a 90-day postoperative period; procedures identified as minor surgery procedures have either a 10-day postoperative period or no postoperative period; and most endoscopic surgery has no postoperative period. 

To determine the global period for major surgeries, count 1 day immediately before the day of surgery, the day of surgery, and the 90 days immediately following the day of surgery. To determine the global period for minor procedures, count the day of surgery and the appropriate number of days immediately following the date of surgery. 

Components of a Global Surgical Package

When different physicians in a group practice participate in the care of the patient, the group bills for the entire global package if the physicians reassign benefits to the group. 

The approved amount for surgical procedures includes payment for the following services related to the surgery when furnished by the physician who performs the surgery:

Services Not Included in the Global Surgical Packages

The following services are not included in the global surgical package and can be paid for separately in addition to the surgical procedure: 

Procedure Codes

Coding Guidelines

References

MCM 4820 - 4822

CMS Online Manual Pub. 100-04, Chapter 12, Section 30/30.6.6

Transmittal 954, CR 5025

MM5025

www.cms.gov
www.medicare.gov

Attachments

Procedure Code Attachments

Diagnosis Codes

Glossary





This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Medicare Advantage plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Medicare Advantage retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Medicare Advantage. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.