Global Procedure Codes and Global Days

Global Procedure Codes and Global Days - Quick Reference

1. Global Day Indicators (CMS)

000 - 0-Day Global
- No pre-op or post-op period.
- Typical for:
  - Minor procedures
  - Many endoscopies
  - Some diagnostic/therapeutic procedures
010 - 10-Day Global
- Surgery day + 10 post-op days (11 total).
- Includes:
  - Procedure
  - Typical post-op visits related to that procedure
090 - 90-Day Global
- 1 pre-op day + surgery day + 90 post-op days (92 total).
- Major surgeries.
045 - 45-Day Global
- Rare category; used for specific maternity/postpartum scenarios.
XXX / 999 - Global Concept Does Not Apply
- No global period.
- Typically:
  - E/M services
  - Labs
  - Diagnostic tests
  - Many radiology and medicine codes

2. Examples by Specialty / Body System

Note

Exact global days are payer- and year-specific. Always verify against the current CMS MPFS or payer policy.

2.1 Integumentary (10000-19999)

Common 10-day global examples

10060 - Incision and drainage of abscess; simple
10061 - Incision and drainage of abscess; complicated
11400-11446 - Benign lesion excision, various sizes/sites
12020-12021 - Simple wound exploration and repair
17000 - Destruction (e.g., premalignant lesion, first lesion)

Common 90-day global examples

11450-11471 - Excision of malignant lesions (by size/site)
13160 - Secondary closure of surgical wound or dehiscence
14000+ - Adjacent tissue transfer/rearrangement (local flaps)
15050 - Surgical preparation of recipient site (e.g., skin graft)

2.2 Musculoskeletal / Orthopedic (20000-29999)

Typically 90-day global

20661 - Injection of joint with ultrasound guidance (check payer; may vary)
21010 - Excision of benign lesion of mandible
23000 - Incision and drainage of shoulder area
27130 - Total hip arthroplasty
27447 - Total knee arthroplasty

(Some minor orthopedic procedures may carry 0- or 10-day globals; verify each code.)

2.3 Ophthalmology (65000-68999)

Common 90-day global example

66984 - Extracapsular cataract removal with IOL (routine cataract)

Minor ophthalmic procedures can be 0- or 10-day global depending on the code.

2.4 GI / Endoscopy (40000-49999, selected)

Many endoscopies and minor GI procedures:

Commonly 0-day global (000) - no post-op period; each encounter distinct.

Major abdominal surgeries:

Typically 90-day global (090).

Examples to verify in MPFS (global likely 0 or 90 depending on complexity):

43235 - Upper GI endoscopy; diagnostic
45378 - Colonoscopy; diagnostic
44120+ - Small intestine resection (major; often 90 days)

2.5 OB / Maternity (59000-59999)

Some OB codes historically associated with 45-day global periods (payer-specific; now often handled via OB package/bundles), e.g.:

59409 - Vaginal delivery only
59410 - Vaginal delivery including postpartum care
59514 - Cesarean delivery only
59515 - Cesarean delivery including postpartum care
59618-59622 - VBAC/C-section with/without postpartum care
59430 - Postpartum care only

Note

Always check current payer OB/global policies for exact handling.

2.6 E/M and “No Global” Services (Most 99202-99499, Labs, Imaging)

Office/outpatient visits (99202-99215): no surgical global - “XXX/999”.
Labs (80047+, 81000+, 87003+): no global.
Many imaging codes (70010+, 93000+): no global, though technical/professional components may apply.

Practical Coding Notes

Use Modifier 57 when the E/M service results in a decision for a major surgery (90-day global) on the same or following day.
Use Modifier 25 for a significant, separately identifiable E/M on the same day as a minor procedure (0- or 10-day global).
Use Modifiers 54, 55, 56 to split the global care between:
- 54 - Surgical care only
- 55 - Postoperative management only
- 56 - Preoperative management only

Note

The official CMS Medicare Physician Fee Schedule (MPFS) Look-Up Tool is your authoritative source, and you can filter by “Global” indicator to see current assignments. Since global periods occasionally change, it’s worth checking the CMS website annually for updates.

Global Days	Count	Description	Example Codes
0 Days (000)	~250+	Endoscopies & minor procedures; no pre-op or post-op period included	10030, 11000, 11004, 29000, 92920, 99213
10 Days (010)	~300+	Minor procedures; 11 total days (day of surgery + 10 post-op days)	10060-10061, 11010, 11400-11446, 12020-12057, 17000, 26341
45 Days (045)	~10-15	Rare category; primarily maternity/postpartum codes	59409, 59410, 59412, 59414, 59430, 59514-59620
90 Days (090)	~1,500+	Major surgical procedures; 92 total days (1 pre-op + day of surgery + 90 post-op)	11450-11471, 13160, 14000+, 19110+, 20661+, 21010+, 27130, 27447, 66984
999 (N/A)	~5,000+	Concept does not apply; diagnostic tests, labs, E/M, vaccines	70010+, 80047+, 81000+, 87003+, 90832+, 93000+, 99201+

Key Code Ranges by Specialty

Integumentary (Skin): 10000-19999

10060-10061 (Incision/drainage) = 10 days
11400-11446 (Benign lesion removal) = 10 days
11450-11471 (Malignant lesion removal) = 90 days

Musculoskeletal (Orthopedic): 20000-29999

20661-20693 (Joint procedures) = 90 days
27130 (Total hip replacement) = 90 days
27447 (Total knee replacement) = 90 days

Eye (Ophthalmology): 65000-68899

66984 (Cataract surgery) = 90 days

ENT (Otolaryngology): 30000-32999

31000+ (Laryngoscopy procedures) = 10 days to 90 days

Cardiovascular/Thoracic: 33000-37999

Most cardiac surgeries = 90 days

GI (Gastroenterology): 43000-47999

Many endoscopic procedures = 0 days
Major GI surgeries = 90 days

For Your E/M Coding Work

Use Modifier -57 (Decision for Surgery) on major procedure E/M visits (90-day global)—this is billable separately.
Use Modifier -25 on same-day E/M if it’s significant and separately identifiable from procedure.
Use Modifiers -54, -55, -56 for split global care between providers.

Quick Reference for Optum E/M Coding

When determining if an E/M is included in a surgical global or billable separately, check:

Is the procedure 0/10/90 day global?
Is the E/M on the procedure day or within the post-op period?
Is it related to the surgery or unrelated?

Sources:

Each of those payers ultimately anchors to Medicare’s global surgery rules, then layers its own reimbursement quirks on top. A practical PDF for you should treat CMS global policy as the base and then flag payer-specific variations you watch for.

Medicare (Traditional + Advantage)

Uses CMS global indicators: 000, 010, 090, XXX, YYY, ZZZ; global days are visible in the Medicare Physician Fee Schedule (MPFS) Look-Up Tool and in Medicare contractor calculators (Novitas, Palmetto, Noridian, etc.).
Medicare Advantage (replacement) plans generally mirror MPFS global days, but may alter:
- Pre-cert/authorization requirements for major surgeries.
- Post-op visit billing rules in SNF/home health situations.
- Modifier handling (especially 54/55/56 and 78/79 for returns to the OR).

Wisconsin Medicaid

Wisconsin Medicaid policy follows the Medicare global framework but may publish its own global days key or code lists, often derived from NCCI and CMS tables.
Watch for:
- Service carve-outs even during global (e.g., some critical care, dialysis, unrelated E/M with proper modifier).
- Prior authorization rules for major surgeries that differ from Medicare timelines.

BCBS of Wisconsin

Commercial BCBS plans generally adopt CMS-style global periods, but policy manuals (often titled “Global Surgery” or “Global Days”) define which services are considered part of the package and which are billable separately.
Common differences:
- Stricter interpretation of what is “related” to the surgery for E/M within global.
- Plan-specific instruction on when Modifier 25 vs 57 is appropriate for office visits near the time of surgery.

UMR, UHC, Cigna, Aetna

These large commercial payers typically:
- Use Medicare global periods as the baseline for physician services.
- Issue plan-specific reimbursement policies (often titled “Global Surgery,” “Global Days,” or “Minor and Major Procedures”) that:
  - Define inclusive vs exclusive services within the global.
  - Spell out exactly how to use Modifiers 54/55/56, 58, 78, and 79 .
  - Sometimes restrict separate payment for post-op E/M more than CMS would.
Many of these payers host online global calculators or policy PDFs in their provider portals; these are excellent to link in your own internal PDF as references.

Medicare/Medicaid Replacement Plans

Medicare Advantage and Medicaid managed care plans administratively follow Medicare/Medicaid, but:
- May require different authorization and documentation to recognize post-op complications vs routine global care.
- Sometimes publish their own “Global Surgery” reimbursement policies that override default CMS interpretations for payment (not coding) purposes.

If you want, the next step can be a payer appendix section you can paste into your PDF, with one short subsection per payer (Medicare, WI Medicaid, BCBS WI, UMR/UHC, Cigna, Aetna, MA/MCO) listing: “Global period source,” “Where to verify,” and “Key modifier notes.”

Payer Appendix - Global Surgery Reference

Medicare (Traditional)

Global period source: CMS Medicare Physician Fee Schedule (MPFS) and MLN Global Surgery booklet.
Where to verify:
- MPFS Look‑Up Tool (field “Global Surgery” / indicators 000, 010, 090, XXX, YYY, ZZZ).
- Your MAC’s online global surgery calculator (e.g., Novitas, Palmetto, Noridian).
Key notes:
- Uses strict 0/10/90‑day rules; post‑op visits related to the surgery are bundled.
- Modifier 57 for E/M resulting in a 90‑day global surgery; Modifier 25 for significant, separately identifiable E/M with 0‑ or 10‑day procedures.
- Modifiers 54/55/56 split pre‑op, intra‑op, and post‑op care.

Medicare Advantage (Medicare Replacement Plans)

Global period source: CMS MPFS; most MA plans mirror Medicare’s global indicators.
Where to verify:
- Plan provider manuals and fee schedules.
- Some MA plans provide their own global surgery policy PDFs on provider portals.
Key notes:
- Coding rules typically follow CMS; prior auth and payment edits may be more restrictive.
- Carefully follow plan rules for complications within global (modifiers 78 vs 79 vs 58).

Wisconsin Medicaid

Global period source: Largely based on CMS/NCCI global surgery logic and key lists.
Where to verify:
- State Medicaid fee schedule and NCCI/global days key PDFs.
- Medicaid provider manuals and policy updates.
Key notes:
- Often mirrors Medicare global days but may treat certain visits/services (e.g., behavioral health, dialysis, some diagnostics) differently during the global.
- Check for special rules on FQHCs, RHCs, and hospital‑based billing.

Medicaid Managed Care / Medicaid Replacement Plans

Global period source: Underlying state Medicaid policy, but each MCO can add reimbursement rules.
Where to verify:
- Individual MCO provider manuals (“Global Surgery” or “Physician Services” sections).
Key notes:
- Coding usually Medicare/Medicaid‑aligned; claim payment (edits/denials) is plan‑specific.
- Watch for plan‑specific requirements for prior auth, referrals, and complication coding inside the global.

BCBS of Wisconsin

Global period source: CMS‑style 0/10/90‑day structure adapted in BCBS reimbursement policies.
Where to verify:
- BCBS WI/Anthem/Blue Cross provider policy labeled “Global Surgery” or “Global Days.”
Key notes:
- Typically follows CMS global days but may narrow what counts as “unrelated” for E/M within the global.
- Pay close attention to policy language on Modifiers 25, 57, 24, 54, 55, 56, 58, 78, and 79 .

UMR / UnitedHealthcare (UHC)

Global period source: Medicare framework plus UHC’s own coverage and reimbursement policies.
Where to verify:
- UHC/UMR provider portal; policy often titled “Global Surgery” or “Global Days.”
Key notes:
- Generally adopts CMS global days; may have tighter edits on E/M during global.
- Some post‑op services (e.g., PT, some imaging) may be allowed separately with correct diagnosis and modifiers.

Cigna

Global period source: CMS global surgery methodology with Cigna payment policy overlay.
Where to verify:
- Cigna Commercial Medical Coverage Policy / Reimbursement Policy - “Global Surgery.”
Key notes:
- Uses 0/10/90‑day logic; defines which services are included in the global package vs billable separately.
- Policy often details expectations for documentation when billing E/M with modifiers 24 or 25 in the global period.

Aetna

Global period source: Medicare‑based global periods with Aetna‑specific reimbursement policies.
Where to verify:
- Aetna Clinical Policy Bulletins and Reimbursement Policies; look for “Global Surgical Package” or “Global Days.”
Key notes:
- Usually mirrors CMS global days for surgery codes; may differ on post‑op visit coverage or carve‑outs.
- Carefully follow Aetna guidance on when unrelated E/M or procedures within the global can be paid separately.

If you’d like, the next chunk can be a 1‑page modifier cheat sheet (24, 25, 57, 54, 55, 56, 58, 78, 79 ) that you can append right after this section in the PDF.

SOURCES:

A concise, global‑period‑focused modifier sheet fits perfectly at the end of your PDF. Here’s clean, paste‑ready content formatted to print well as one page.

Global Period Modifier Cheat Sheet (Physician Services)

24 - Unrelated E/M During Post‑Op Period
- Use when: E/M service during a 10‑ or 90‑day global is for a condition unrelated to the surgery.
  Example: Patient had TKA (27447, 90‑day global) and later seen for new URI.
25 - Significant, Separately Identifiable E/M, Same Day as Procedure
- Use when: Same‑day minor procedure (0‑ or 10‑day global) and the E/M is above and beyond the usual pre‑/post‑op work.
  Example: Office visit with full evaluation, plus lesion excision (11401).
57 - Decision for Surgery (Major)
- Use when: E/M service leads to a 90‑day global (major) procedure performed that day or the next day.
- Typically used on office/consult/H &P codes (e.g., 99223 ) when deciding for major surgery.

Surgical Care Split Modifiers

54 - Surgical Care Only
- Use when: Surgeon performs only the intra‑operative portion; another physician handles pre‑ and/or post‑op care.
- Common for: Referring surgical care when a patient’s PCP or local surgeon manages follow‑up.
55 - Postoperative Management Only
- Use when: Provider renders only the post‑op care for a procedure done elsewhere.
- Requires: Same CPT as the surgery + modifier 55 and appropriate dates of service.
56 - Preoperative Management Only
- Use when: Provider performs only the pre‑op evaluation/management for a surgery done by another provider.
- Less common; follow payer‑specific instructions carefully.

Modifiers for Procedures During the Global

58 - Staged or Related Procedure or Service During Post‑Op Period
- Use when: A planned, more extensive, or staged procedure is performed during the global period of the original surgery.
- Effect: Starts a new global period for the second procedure.
78 - Unplanned Return to the OR for Related Procedure During Post‑Op Period
- Use when: Patient returns to the OR for a related procedure due to complications of the original surgery.
- Effect: Does not start a new global period; payment usually reduced (intra‑op only).
79 - Unrelated Procedure or Service by Same Physician During Post‑Op Period
- Use when: A completely unrelated procedure is performed during the global of another surgery.
- Example: Patient with healing TKA (90‑day global) later needs unrelated gallbladder surgery.
- Effect: Starts a new global period for the unrelated procedure.

Practical Tips Across Payers

Always pair the correct modifier + clear documentation of why the E/M or procedure is unrelated, staged, or separate; Medicare and commercial payers publish global surgery and modifier policies that should be checked regularly.
For your mix of Medicare, WI Medicaid, BCBS WI, UMR, UHC, Cigna, Aetna, and replacement plans, the meaning of these modifiers is Medicare‑based, but payment edits and prior auth rules vary, so keep payer‑specific policies bookmarked in your PDF appendix.

Sources:

Explorer

Global Procedure Codes and Global Days - Quick Reference