I have transplant surgeons who insist on billing for the H&P for a renal transplant with CPTs 99221-99223 with modifier -57 to indicate a decision for surgery. I have advised them that the H&P is bundled into the major surgery global package, and it should not be separately billed. The patient's have already been evaluated for the renal transplant on a previous day of service in the office setting (billed w/ outpatient E/M) where the decision to move forward with the transplant has initially been made. The surgeon's argument is that they have to reevaluate the patient on the day of the transplant to ensure the patient is healthy enough to undergo this major surgery; therefore they are making the decision to perform major surgery. To me this is standard of care and is also hospital policy to perform the H&P for all surgeries. I am worried that the H&P is inappropriately being unbundled from the global package. CMS does allow the surgeon to bill subsequent hospital visits within the global for immunosuppression therapy using modifier -24, but I cannot find any caveat re: the H&P with modifier -57. Our local Medicare carrier does not provide any specific guidance for this. Has anyone experienced this scenario before? Any information is much appreciated.