Medicare Global Surgery Period Guide

Learn how Medicare global surgery periods work, which services are included in the surgical package, and when modifiers allow services to be reported separately. Choosing between them matters. CMS states that Modifier 59 is frequently used incorrectly and that a more specific modifier should be used when one accurately describes why the services are distinct. The X{EPSU} modifiers provide more specific alternatives for separate encounters, practitioners, structures, and unusual non-overlapping services

5/25/20266 min read

Home > All Guides > Medicare Guides > Medicare Global Surgery Period Guide

Medicare Global Surgery Period Guide

Understanding 0-Day, 10-Day, and 90-Day Global Periods

Learn how Medicare global surgery periods work, which services are included in the surgical package, and when modifiers allow services to be reported separately.

Author: Gabriel Rojas
Updated: September 2026 • 8 min read

Medicare's global surgery rules combine certain services related to a surgical procedure into a single payment. Depending on the procedure, Medicare may assign a 0-day, 10-day, or 90-day global period.

Understanding these periods is important because services that are normally included in the global surgical package generally cannot be separately billed. However, certain circumstances—including unrelated care, staged procedures, returns to the operating room, and transfers of care—may require specific modifiers.

CMS identifies each procedure's global surgery status in the Medicare Physician Fee Schedule

Global Surgery Period

Services Included

E/M Services

Procedures Durind Period

Postoperative Care

Common Mistakes

Guide Categories

Modifier Comparisons

Billing Guides

Documentation Tips

Common Denials

Medicare Guides

What Is the Medicare Global Surgery Period?

The Medicare global surgery package combines payment for the surgical procedure with certain related services furnished before, during, and after surgery.

Instead of separately paying for every routine service associated with the procedure, Medicare includes qualifying services in the payment for the surgery.

The Medicare Physician Fee Schedule uses several global surgery indicators:

000 — 0-Day Global Period: Related preoperative and postoperative work on the day of the procedure is included. There is no postoperative period beyond the procedure date.

010 — 10-Day Global Period: Related preoperative services on the procedure date and postoperative services during the following 10-day period are included.

090 — 90-Day Global Period: Major surgery. Medicare includes a one-day preoperative period and a 90-day postoperative period.

MMM: Maternity codes. The standard global surgery concept does not apply.

XXX: The global surgery concept does not apply.

YYY: The Medicare Administrative Contractor determines whether a global period applies when pricing the service.

ZZZ: The code is related to another service and assumes the global period assigned to the primary procedure. This is commonly seen with add-on codes.

The global indicator for a particular procedure can be checked through the Medicare Physician Fee Schedule.

What Services Are Included in the Global Surgical Package?

The global package generally includes services that are normally part of performing the procedure and providing routine recovery care.

Depending on the procedure and global period, bundled services may include:

Preoperative Visits: Routine visits related to the surgery that fall within the applicable global period.

Intraoperative Services: Services normally necessary to perform the surgical procedure.

Routine Postoperative Visits: Follow-up care related to recovery from the procedure during the postoperative period.

Postoperative Pain Management: Routine postoperative pain management performed by the physician who performed the procedure is generally included.

Routine Surgical Supplies and Services: Services considered integral to performing the procedure are generally not separately reportable.

Treatment of Routine Postoperative Issues: Care normally associated with recovery from the surgery is generally included in the global payment.

For example, Medicare NCCI policy states that routine control of postoperative bleeding that does not require a return to the operating room is included in the global package. A return to the operating room for treatment of a related complication may instead qualify for separate reporting with Modifier 78.

The global package does not mean that every service provided during the postoperative period is automatically bundled. The relationship between the new service and the original surgery must be considered.

E/M Services During a Global Period

Evaluation and management services are a common source of global surgery billing errors.

Routine E/M services related to the patient's recovery from surgery are generally included in the global package. However, several modifiers identify circumstances in which an E/M service may qualify for separate reporting.

Modifier 24 — Unrelated E/M Service During Postoperative Period

Modifier 24 identifies an E/M service furnished during a postoperative period that is unrelated to the original procedure.

The documentation should establish why the new evaluation is unrelated to the surgery rather than routine postoperative management.

Modifier 25 — Significant, Separately Identifiable E/M Service

Modifier 25 may apply when a significant, separately identifiable E/M service is performed on the same day as a minor procedure.

The E/M service must go beyond the usual preoperative and postoperative work associated with the procedure.

Modifier 57 — Decision for Surgery

Modifier 57 identifies an E/M service that results in the initial decision to perform major surgery.

CMS guidance applies Modifier 57 to major procedures with a 90-day global period. The decision for a minor procedure is generally considered part of the routine preoperative work and does not qualify for Modifier 57.

These modifiers do not automatically make an E/M service payable. The medical record must support the circumstances represented by the modifier.

Procedures During the Postoperative Period

Additional procedures performed while a patient is still within a global period require careful modifier selection.

Three important modifiers distinguish very different circumstances.

Modifier 58 — Staged or Related Procedure

Modifier 58 may be used for a staged or related procedure during the postoperative period when the procedure was planned prospectively, is more extensive than the original procedure, or represents therapy following a diagnostic surgical procedure.

A qualifying Modifier 58 procedure generally begins a new postoperative period.

Modifier 78 — Unplanned Return to the Operating/Procedure Room

Modifier 78 identifies an unplanned return to the operating or procedure room for a related procedure during the postoperative period.

For example, CMS states that postoperative control of bleeding requiring a return to the operating room may be separately reportable with Modifier 78.

Unlike Modifier 58, a Modifier 78 procedure does not represent an unrelated procedure and is treated differently within the existing global period.

Modifier 79 — Unrelated Procedure

Modifier 79 identifies a procedure performed during the postoperative period that is unrelated to the original surgery.

A qualifying unrelated procedure establishes its own global period based on the global surgery indicator assigned to that procedure.

The distinction is important:

58: Staged or related procedure.

78: Unplanned return for a related procedure.

79: Completely unrelated procedure.

CMS recognizes Modifiers 58, 78, and 79 as global-surgery modifiers that may also function as NCCI PTP-associated modifiers when the applicable circumstances are satisfied.

Transferring Preoperative, Surgical, and Postoperative Care

Sometimes one practitioner performs the surgery while another practitioner provides some portion of the preoperative or postoperative management.

Medicare uses Modifiers 54, 55, and 56 to distinguish portions of the global package.

Modifier 54 — Surgical Care Only

Modifier 54 identifies the surgical portion when the billing practitioner does not furnish the entire global package.

CMS broadened its Modifier 54 policy beginning in 2025 for 90-day global surgical packages. Modifier 54 applies when a practitioner expects to furnish only the surgical procedure portion, including situations beyond a formal documented transfer of care.

Modifier 55 — Postoperative Management Only

Modifier 55 identifies postoperative management furnished by a practitioner other than the practitioner reporting the surgical portion.

CMS instructs the postoperative practitioner to use the same surgical procedure code and date of surgery when reporting the postoperative component. The practitioner accepting postoperative care must furnish at least one service before billing for that portion.

Modifier 56 — Preoperative Management Only

Modifier 56 identifies the preoperative management portion of a global surgical package when applicable.

The Medicare Physician Fee Schedule contains separate percentages representing the preoperative, intraoperative, and postoperative portions of qualifying global procedures. These percentages are used when payment for the global package must be divided.

Accurate documentation of who provided each portion of care is particularly important when the global surgical package is divided among practitioners.

Documentation, Billing, and Common Global Surgery Mistakes

Global surgery claims should clearly establish the relationship between the original surgery and any separately reported service during the global period.

Verify the Global Indicator: Check whether the procedure has a 000, 010, 090, XXX, YYY, ZZZ, or other applicable global indicator before determining whether subsequent services are included.

Document Unrelated Services: When using Modifier 24 or 79, the medical record should demonstrate why the new service or procedure is unrelated to the original surgery.

Document Separate E/M Work: Modifier 25 requires documentation supporting significant E/M work beyond the usual work associated with the minor procedure.

Document the Decision for Major Surgery: Modifier 57 should be supported by documentation showing that the E/M encounter resulted in the initial decision for the major surgical procedure.

Distinguish 58, 78, and 79: Do not treat these modifiers as interchangeable. The relationship of the subsequent procedure to the original surgery determines the appropriate modifier.

Document Transfers of Care: When different practitioners furnish portions of the global package, records should support the division of care and applicable 54, 55, or 56 reporting.

Do Not Bill Routine Postoperative Care Separately: Services already included in the global surgical package should not be separately reported simply because they occurred during a separate office visit.

CMS's 2026 NCCI policy also states that modifiers should only be appended when the clinical circumstances justify their use. A modifier should never be added solely to bypass an NCCI edit.

CMS continues to emphasize accurate reporting of postoperative visits and global surgery services.

Frequently Asked Questions

How do I find the global period for a CPT code?
Use the Medicare Physician Fee Schedule and review the procedure's Global Surgery indicator. Medicare identifies 000, 010, and 090 global periods along with indicators such as XXX, YYY, and ZZZ that describe how the global surgery concept applies.

Can an unrelated service be billed during a 90-day global period?
Yes, when the service satisfies Medicare's requirements for separate reporting. Modifier 24 may identify an unrelated E/M service, while Modifier 79 may identify an unrelated procedure performed during the postoperative period. Documentation must support why the service is unrelated to the original surgery.