The global period is one of the most important and one of the most frequently misunderstood concepts in coding. The global period is the defined timeframe after surgery that includes all routine follow-up care as it relates to the surgical procedure being billed for and cannot be billed for separately. It is important for coders to have a thorough understanding of the global period to assure proper coding (billing), compliance, and the best reimbursement possible. Missing or misunderstanding the global period can result in underbilling, overbilling and/or denial of a claim altogether. This useful guide will give coders all the information they need to know (definition, examples, modifiers, pitfalls, and 2025 updates) about global periods.
What is the Global Period?
The global period (also referred to as the global surgical package or global days) is a designated time frame (i.e., a set number of days) meant to account for the associated preoperative, intraoperative, and postoperative services that are included in one payment for a specific surgical procedure. To clarify, any services provided during this designated period which are associated with the surgical procedure cannot be billed separately. The global period is categorized by the Medicare Physician Fee Schedule (MPFS) for all Medicare services and the majority of commercial payors.
Example: After a patient has had their gallbladder removed, there may be routine follow-up visits, including post-operative evaluations, suture removal, and a wound check so these visits are included in the global payment for the surgical procedure. However, if the patient develops an unrelated issue such as a skin rash, those services can be billed separately, often by adding a modifier to indicate that the service is unrelated to the surgical procedure. It is important to understand and code global time appropriately, to be compliant and to avoid denials for services already accounted for in the surgical procedure’s global payment.
Global Period Types
Global periods differ based on the complexity of the procedure. Within the MPFS, each CPT® code has a global indicator (000, 010, or 090) clarifying how many days of post-op care were included.
Tip: Always check the global indicator for each CPT, while using the Medicare Physician Fee Schedule lookup, in order to confirm the correct global period, and avoid billing mistakes.
What Is Covered in the Global Period?
Usually, the global fee for surgery covers the following services:
- Pre-operative visits – Routine visits right before the surgery (excluding the initial E/M visit that led to scheduling for surgery).
- Intraoperative services – The surgery, plus normal intraoperative care.
- Postoperative care – Routine follow-up visits, medication for pain, follow-up wound care, the removal of sutures/staples, and the normal management of complications that do not require a return to the OR.
- Supplies – Such as dressings, sutures, and casting supplies.
- Management of events related to the standard postoperative process – A routine process of care during healing and recovery.
Providers under the same group and specialty on the same date of service are to bill as a single physician for all global-period services.
What’s Not Included in the Global Period?
Some services may not be included in the bundled payment and may be billed separately with modifiers and appropriate documentation:
2025 update: CMS introduced code G0559 for postoperative follow-up E/M visits by a provider that was not part of the surgery and that did not have a formal transfer of care. This can be billed once per 90-day global period.
Key Modifiers for Global Period Billing
Modifiers are essential tools for coders to distinguish between bundled and separately payable services. Here’s a summary of the most common modifiers related to the global period:
To avoid a claim denial, you must document thoroughly and clearly to support any modifiers used on the claim. Documentation is necessary regardless of the accuracy of the coding.
Real Examples:
1. Catact surgery (90-day global period) — A patient develops a skin infection to an unrelated organism on postoperative day 40 → Submit a separate bill, with modifier 24.
2. Wound repair (10-day global period) — Suture removal on postoperative day 5 → Considered part of the global period and not submitted separately.
3. Knee replacement surgery (90-day global period) — Follow-up with planned arthroscopy to allow therapy to the knee → Submit bill with modifier 58; counts as a new global period.
4. Post-operative abscess that requires the operating room → The abscess is billed separately with a modifier 78, but this does not reset global period.
Common Mistakes (and How to Fix Them)
Even the most experienced coders can do mistakes related to a global period. Here are some common problems and fixes they did:
- Submitting a claim with the bundled global period for post-operative care
Always verify the global period, on the CPT code before submitting a claim for the follow up visit.
- Submitting a claim with a modifier, and using the wrong modifier
Have a quick reference of modifiers and when to use them. Modifying improperly (i.e. 24 vs 79) is a leading cause of denials.
- Not remembering provider group rules
Keep in mind that provider in the same specialty and tax ID and, for billing purposes, treated as one.
- Incorrectly identifying the global period
Remember 90-day procedures generally begin 1 day before surgery and 10-day procedures start the day of surgery, while 0-day procedures are only for that day.
- Not specifying that the visit procedure is unrelated
Make sure the medical notes indicate in clear terms that the visit or procedure was unrelated to the surgery.
- Not checking payer updates
Always check the current MPFS indicators (and updates from CMS) to stay current, as coding changes can be significant from year to year.
Compliance and 2025 Updates
The Office of Inspector General (OIG) is heightening audits tied to accuracy of post-operative reporting. Coders and providers should make sure that modifiers are used correctly, any transfers of care situations are documented, and billing and modifiers related to global period rules, are used accurately.
Highlights for 2025 include:
- New code G0559 for post-operative follow-up for non-surgical providers.
- Tighter focus on claims using modifiers 54, 55, and 56 without evidence of transfer of care.
- Harder compliance requirements for multi-specialty groups and shared care situations.
Maintaining compliance protects both revenue and reputation. Coders should be clear in documentation, double-check logic for modifier use, and educate providers consistently.
Best Practices for Medical Coders
To master global period coding and maintain compliance, adopt these best practices:
- Keep a helpful reference for CPT codes and the respective global period indicators readily available. (0 days, 10 days, or 90 days).
- 2. Train providers and billing offices on what is included and excluded during global periods.
- 3. Use modifier checklists so everything stays consistent and reduces the chances of mistakes.
- 4. Frequently audit global period claims to catch incorrect billing or when a modifier was not added.
- 5. Ensure that documents properly transfer care when multiple providers are involved.
- 6. Stay updated to CMS and payer updates because rules change and are updated annually due to reimbursement.
- 7. Make sure to check MPFS lookup tools to properly set up any surgical claim coding.
- 8. Make sure to document everything clearly because clinical notes will help reduce risk if ever audited.
Conclusion:
Successful global period coding is about more than payment. It assures compliance, prevents denials, and builds trust between providers and payers. Coders facilitate protection of the revenue stream and regulatory integrity when they know what services are bundled together for the global period, and which services can be billed individually. Coders show their professional competency by mastering the rules concerning the global period, and they blend all three foundational aspects of healthcare: clinical, operational, and financial. In 2025, with new codes and documentation standards, we will need to stay aware, correct, and detailed. By knowing your indicators of global period, modifier usage, and precise documentation will ensure coders at least participate in creating clean claims processing, compliant billing, and confidence that they can release claims competently. For those of you interested in expanding your skill set, the CareerInPharma Medical Coding Course will offer significant additional education on CPT®, ICD-10-CM, and HCPCS coding to complement the course content with case studies in surgical and global period billing.
Whether you are starting your career or looking to move into a specialty role, CareerInPharma will prepare you with the accuracy, knowledge, and confidence to be successful in today’s healthcare environment. Enroll today and take the next step towards being a competent and trusted medical coding professional.
