Medicare_Carriers_Manual / 4822 / 4822

Why This Topic Matters

Global surgery billing affects whether services are bundled or separately payable, and this guidance helps reduce claim errors, denials, and inconsistent reporting across surgical episodes and payment localities.

Article Sections

1. Ed. Note: For further information see

   References to related Medicare manual material covering critical care services and global billing topics.

2. 4822. Billing Requirements for Global Surgeries

   Overview of the rules for identifying services included in or excluded from the global surgical package.

3. Procedure Codes and Modifiers

   General reporting guidance for surgery-related claims and the use of modifiers in global period situations.

4. Physicians Who Furnish the Entire Global Surgical Package

   Billing framework when one physician provides the full preoperative, operative, and postoperative package.

5. Physicians in Group Practice

   How group practice billing applies when multiple physicians participate in care during the global period.

6. Physicians Who Furnish Part of a Global Surgical Package

   Reporting considerations when care is transferred during the global period and different physicians bill different portions of the episode.

7. Evaluation and Management Service Resulting in the Initial Decision to Perform Surgery

   Guidance on reporting evaluation and management services tied to the decision to proceed with major surgery.

8. Return Trips to the Operating Room During the Postoperative Period

   Rules for reporting procedures performed when a patient returns to the operating room during postoperative recovery.

9. Staged or Related Procedures

   Billing considerations for planned or related procedures performed during a postoperative period.

10. Unrelated Procedures or Visits During the Postoperative Period

    How to report services during a postoperative period that are not related to the original surgery.

11. Significant Evaluation and Management on the Day of a Procedure

    Separate reporting rules for evaluation and management services furnished on the same day as a procedure.

12. Critical Care

    Medicare policy for critical care services furnished during a global surgical period and the related documentation expectations.

13. Unusual Circumstances

    General guidance on reporting surgeries that require significantly more or less work than usual.

14. Date(s) of Service

    Instructions for showing surgery and postoperative care dates when billing the global package or split care.

15. Care Provided in Different Payment Localities

    Billing considerations when surgical and postoperative portions of a global period occur in different payment localities.

16. Health Professional Shortage Area (HPSA) Payments for Services Which are Subject to the Global Surgery Rules

    How HPSA-related payment handling applies when services within a global surgical episode are furnished in designated areas.