What the fee already covers Copy link
For the surgeon who performs the procedure, the package includes pre-operative visits once the decision to operate is made (from the day before major surgery, or the day of a minor one), the procedure itself, related follow-up visits, post-surgical pain management, complications that don’t need a return to the operating room, and routine items such as dressing changes and suture removal. None of these are billed separately.
What it leaves out Copy link
Visits unrelated to the surgery, treatment of the underlying condition, diagnostic tests, a clearly distinct new procedure, and a return to the operating room for complications are paid separately. So is the visit that leads to the decision to perform major surgery. Care by other physicians is outside the package unless the surgeon formally transfers post-operative care to them.
Visits on the day of a minor procedure Copy link
A visit by the same physician on the day of a minor procedure or endoscopy is included in the procedure’s payment, unless the physician also performs a significant, separately identifiable evaluation. That is what modifier 25 reports. Deciding that the patient needs the procedure doesn’t count: for a minor procedure, that decision is part of the package.
Global period values Copy link
The RVU file’s GLOB DAYS column carries one of seven values:
| Value | Meaning |
|---|---|
| 000 | Minor procedure or endoscopy; the package covers the day of the procedure only |
| 010 | Minor procedure; the package covers the day of the procedure and related care for 10 days after |
| 090 | Major surgery; the package covers the day before, the day of, and related care for 90 days after |
| XXX | The global surgery concept does not apply |
| YYY | Contractor-priced; the Medicare Administrative Contractor sets a 0-, 10-, or 90-day period |
| ZZZ | Add-on code; the primary procedure’s global period applies |
| MMM | Maternity code; the usual global period does not apply |
Modifiers that mark the exceptions Copy link
A claim inside a global period uses a modifier to show that a service falls outside the package:
| Modifier | Reports |
|---|---|
| 24 | An unrelated visit by the same physician during the post-operative period |
| 25 | A significant, separately identifiable visit on the day of a procedure |
| 57 | The visit that resulted in the decision for major surgery, on the day before or the day of |
| 78 | A related return to the operating room during the post-operative period |
| 79 | An unrelated procedure during the post-operative period; it starts its own global period |
| 54 / 55 | Surgical care only / post-operative management only, when care is transferred |
Global period calculator Copy link
Enter a code and, optionally, the date of surgery to see which days its global surgical package covers.
Try , , ,
27447 · Q4 2026 release
The global period for 27447 runs from Sun, Jan 4, 2026 through Sun, Apr 5, 2026.
Major surgery. The fee covers the day before surgery, the day of surgery, and the 90 days after it. Related follow-up care inside that window is not billed separately.
- Starts (day before surgery)
- Jan 4, 2026
- Surgery
- Jan 5, 2026
- Last post-op day
- Apr 5, 2026
A related visit on Apr 6, 2026 or later is outside the package.
Days counted the way CMS counts them (Claims Processing Manual ch. 12 §40.1.E). The package covers related care by the surgeon; whether a visit is related depends on the documentation.
Frequently asked Copy link
Can I bill an office visit during a global period?
Only if the visit is unrelated to the surgery, billed with modifier 24 and a diagnosis that shows it. Related follow-up, including complications that don’t need a return to the operating room, is already paid in the surgery’s fee.
Does 99213 have a global period?
No. Office visit codes carry XXX, so the concept does not apply to them. A 99213 can still fall inside another procedure’s global period, which is when modifiers 24 and 25 matter.
When does a global period start?
For major (090) surgery, the day before the procedure. For minor (000 and 010) procedures, the day of the procedure.
Sources Copy link
- CMS Medicare Claims Processing Manual (Pub. 100-04)
- CMS Medicare Physician Fee Schedule Relative Value Files
Written from primary CMS sources—see how we source, compute, and verify everything on this site.
- Codes with 090 in the global surgery field are major surgeries; codes with 000 or 010 are minor surgical procedures or endoscopies; for YYY codes the contractor sets a 0-, 10-, or 90-day period; ZZZ add-on codes take the primary procedure’s global period. —CMS Medicare Claims Processing Manual (Pub. 100-04)
- The package includes pre-operative visits beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures. —CMS Medicare Claims Processing Manual (Pub. 100-04)
- Visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure, unless a significant, separately identifiable service is also performed. —CMS Medicare Claims Processing Manual (Pub. 100-04)
- Modifier 24 reports an unrelated E/M service during a post-operative period, 57 the visit that results in the initial decision for major surgery, 78 a related return to the operating room, and 79 an unrelated procedure, which begins a new post-operative period. —CMS Medicare Claims Processing Manual (Pub. 100-04)
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