CMS updates global surgery billing guidance

CMS recently updated its MLN Booklet on Medicare’s global surgery package to provide additional information on transfer of care modifiers and new Healthcare Common Procedure Coding System (HCPCS) G-code G0559.

Medicare’s global surgery package includes all necessary services usually provided by a provider before, during, and after a procedure, according to CMS. Physicians within the same group practice and specialty must bill as though they are a single physician.

CMS classifies global surgery packages into the following three groups:

• 0-day post-operative period (endoscopies and some minor procedures)
• 10-day post-operative period (other minor procedures)
• 90-day post-operative period (major procedures)

Organizations can use the Medicare Physician Fee Schedule look-up tool to identify covered surgical procedures and their post-operative periods.

The booklet details the services that are included in global surgery payment and those that are not. For example, any pre-operative visit after the decision to operate is included in the package, but a surgeon’s first evaluation to determine the need for major surgery should be billed separately.

CMS updated its global surgery coding and billing guidelines to reflect changes in the 2025 Medicare Physician Fee Schedule (MPFS) final rule.

When providers agree on a transfer of care during the global period, they must bill with one of the following modifiers:

• -54 (surgical care only)
• -55 (post-operative management only)
• -56 (pre-operative care only)

CMS clarified that modifier -54 shows the surgeon transferred all or part of the post-operative care and is to be used in any case when a practitioner plans to provide only part of the global package. This includes but is not limited to when there’s a formal, documented transfer of care or an informal, non-documented but expected, transfer of care, according to the booklet.

CMS added information on new HCPCS add-on code G0559 for post-operative care service provided by a practitioner other than the one who did the surgical procedure or another practitioner in the same practice. This code reflects the time and resources involved in post-operative follow-up visits provided by practitioners who did not provide the surgical procedure, according to the agency.

The booklet provides extensive guidance on pre-operative, procedure day, and post-operative billing and coding requirements, as well as special billing situations and assistant-at-surgery services. Revenue integrity professionals can find more information about these updates in the 2025 MPFS final rule. Read Chapter 12 of the Medicare Claims Processing Manual for more information on global surgery billing requirements.