UHC REIMBURSEMENT POLICY
CMS-1500
Policy Number 2020 R0005C
Global Surgery applies in any setting,
including an inpatient hospital, outpatient hospital, Ambulatory Surgical Center
(ASC), and physician’s office. Visits to a patient in an intensive care or critical care unit are also included in the Global
Surgical Package if made by the surgeon.
There are three types of Global Surgical Packages based on the number of post
-
operative days.
Zero Day Post operative Period, (endoscopies and some Minor Procedures).
•
No preoperative period
•
No post
-
operative days
•
Visit on day of procedure is generally not payable as a separate service
10
-
day Post
-
operative Period
, (other Minor Procedures).
•
No preoperative period
•
Visit on day of the procedure is generally not payable as a separate service
•
Total global period is
11 days. Count the day of the surgery and 10 days following the day of the surgery
90
-
day Post
-
operative Period
(Major Procedures)
•
One day preoperative included
•
Day of the procedure is generally not payable as a separate service
•
Total global period is 92 days. Count 1 day before the day of the surgery, the day of surgery, and the 90 days
immediately following the day of surgery.
The payment rules for Global Surgical Packages apply to procedure codes with global surgery indicators of 000, 010,
090, and, sometimes, YYY.
While codes with “ZZZ” are surgical codes, they are add
-on codes that are always billed with another service. There is
no postoperative work included in the NPFS payment for the “ZZZ” codes. Payment is made for both the primary and
the add on codes, and the global period assigned is applied to the primary code
