Ten Services You Can Bill Medicare for Separately From a Surgical Procedure

Medicare’s global surgical package covers all the necessary services a surgeon normally furnishes before, during, and after a procedure for a defined period. The following services fall outside “normal,” so you can bill Medicare for them separately from that surgical procedure.

  1. The surgeon’s initial consultation or evaluation of the problem to determine the need for major surgeries (billed separately using modifier 57, decision for surgery). The initial evaluation for minor surgical procedures and endoscopies is always included in the global surgery package.
  2. Services of other physicians related to the surgery, except where the surgeon and the other physician(s) agree on the transfer of care via a letter or an annotation in the discharge summary or in the hospital or ambulatory service center record.
  3. Visits unrelated to the diagnosis for which the surgical procedure is performed unless the visits occur due to complications of the surgery.
  4. Treatment for the underlying condition or an added course of treatment not part of normal recovery from surgery.
  5. Diagnostic tests and procedures, including diagnostic radiological procedures.
  6. Clearly distinct surgical procedures that occur during the post-operative period and are not reoperations or treatment for complications. (Note: A new post-operative period begins with the subsequent procedure. This includes procedures done in two or more parts for which the decision to perform the surgery in stages is made ahead of time or at the time of the first procedure.)
  7. Treatment for post-operative complications requiring a return trip to the operating room (OR), defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes cardiac catheterization, laser, and endoscopy suites but not a patient’s room, a minor treatment or recovery room, or an intensive care unit (unless the patient’s condition was so critical there was not time to move the patient to the OR).
  8. A second procedure performed when a less extensive procedure fails and a more extensive procedure is required.
  9. Immunosuppressive therapy for organ transplants.
  10. Critical care services (CPT codes 99291 and 99292) unrelated to the surgery where a seriously injured or burned patient is critically ill and requires constant attendance.

Source: The Centers for Medicare & Medicaid Services’ Global Surgery Booklet, updated August 2017. See the booklet for information about coding, special billing situations, and more.

Also, visit the Global Surgery page on the Novitas Solutions website for information, including FAQs and a global surgery calculator.

Have questions about billing and coding or payer policies? Contact TMA’s reimbursement specialists at paymentadvocacy[at]texmed[dot]org, or (800) 880-7955. Learn more about Medicare, especially what's new for 2019 and next steps under the Medicare Access and CHIP Reauthorization Act (MACRA), at TMA’s popular annual Medicare update seminar. Register now for the half-day seminar, Back to the Future of Medicare, which runs Nov. 14-Dec. 7 at a city near you, or for the live webcast on Dec. 7. 

Published Nov. 7, 2017

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Last Updated On

November 08, 2017

Originally Published On

November 07, 2017

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