Medicare_Claims_Processing_Manual / Chapter_12 / CMS 100-4, 12 §40.3(B)

Why This Topic Matters

Understanding these CMS edits helps billing teams recognize when a service may be part of the global package and when additional documentation or modifier usage is relevant. It supports more accurate claim processing and compliance review for global surgery scenarios.

Article Sections

1. Prepayment Edits to Detect Separate Billing of Services Included in the Global Package

   Overview of the carrier prepayment edit concept used to identify services that may be considered part of a global surgical or endoscopy package. The section addresses the general claim timing, provider, and period-based conditions involved.

2. Evaluation and Management Codes for Carrier Edits

   A list of evaluation and management codes referenced for carrier edit purposes. This section supports identification of the visit categories included in the article’s edit framework.

3. NOTE

   Additional guidance concerning critical care and documentation during the preoperative or postoperative period, along with related nursing facility admission considerations.