Medicare_Carriers_Manual / 15501 / 15501

Why This Topic Matters

Global surgery rules affect whether evaluation and management services are payable separately from a procedure. Understanding the policy helps billing and compliance teams avoid inappropriate denials, reduce documentation gaps, and apply Medicare carrier guidance consistently.

Article Sections

1. 15501.1 Payment For Evaluation and Management Services Provided During Global Period Of Surgery

   Overview of Medicare carrier guidance for evaluation and management services furnished during global surgical periods. The section is organized by specific modifier-based scenarios and includes documentation and payment considerations.

2. A. CPT Modifier 24

   Discussion of carrier policy related to evaluation and management services furnished during the postoperative period when the service is considered separate from surgical care. The section includes hospital-stay context and documentation expectations.

3. B. CPT Modifier 25

   Guidance on evaluation and management services reported on the same date as a procedure with a global fee period. The section addresses general payment treatment and identifies circumstances that may trigger additional documentation or review.

4. C. CPT Modifier 57

   Policy discussion for evaluation and management services associated with the decision to perform surgery within a global surgical period. The section distinguishes between procedures with different global period lengths.