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Thread: Percentage of allowed given for Pre-op, Post op and Procedure/Global for Medicare

  1. #1

    Question Percentage of allowed given for Pre-op, Post op and Procedure/Global for Medicare

    AAPC: Back to School
    Looking for a breakdown. I was in a Webinar which of course now I cannot find, can anyone tell me the breakdown as in a percentage of what Medicare pays there physician based on the surgery, i.e. 10% pre-op 10% post op care 80% Procedure/CPT. We are an Orthopaedic group-one surgeon is on Hiatis for a year, the other docs are picking up his patients, which include post ops-I know I cannot bill 55 mod since we are a group-but my manager wants a breakdown to take from that physican to give to the curretn physician for there post care of the patient. Hope this makes sense, any advise here will be appreciated.

  2. #2
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    According to Encoder Pro, for a 90 day global, it is 10% pre-op, 69% intra-op, and 21% post-op for Medicare, for codes 22595 and 27130. However, when I look up a tissue transfer code (11400), it is 10%, 71%, and 19%.

    You would have to check your contracts with other insurance companies to see what their allowances are.

    Hope this helps,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3

    Talking Yes that helps tremendously

    Thanks Cindy

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