Medicare_Carriers_Manual / 4824 / 4824

Why This Topic Matters

Global surgery billing affects whether claims are paid, reduced, or denied, and how notices are communicated to beneficiaries and providers. Understanding this section helps avoid improper separate billing and supports correct claims adjudication workflows.

Article Sections

1. A. Fragmented Billing of Services Included in the Global Package

   Discusses Medicare adjudication when surgery-related services are billed separately from a global surgical package. Includes general payment handling, documentation-related review, and related beneficiary and provider messaging.

2. B. Claims From Physicians Who Furnish Less Than the Global Package (Split Global Care)

   Covers claims where more than one physician furnishes portions of surgical care. Describes how Medicare applies split-care payment processing and how payment portions are handled.

3. EXAMPLE

   Provides an example illustrating split global care payment allocation across physicians over the postoperative period.

4. C. Payment for Return Trips to the Operating Room for Treatment of Complications

   Addresses Medicare payment processing when complications require a return to the operating room. Also discusses circumstances involving unlisted procedures and additional procedures during the operative or postoperative period.

5. D. EOMB and Remittance Messages

   Lists explanation-of-benefits and remittance advice messages used for global surgery claim outcomes. Covers message categories for fragmented billing, split global packages, stand-alone procedures with a special global period, and claims lacking supporting documentation.