The OIG’s 2025 Work Plan puts global surgery billing compliance under the microscope—focusing on postoperative care documentation and proper claim submissions. With new coding changes and stricter modifier requirements, healthcare providers must adapt quickly to avoid denials, audits, or payment delays.
At Quick Claim Med, we help practices navigate Medicare’s global surgery rules with accurate coding, clean claims, and full compliance. Here’s what you need to know for 2025.
What Is the Global Surgery Package?
Medicare bundles payment for surgical procedures and related services into a single “global” payment, covering:
✅ Pre-op visits (1 day before surgery for 90-day procedures)
✅ Intraoperative services (the surgery itself)
✅ Post-op care (follow-up visits, pain management, supplies)
Global Period Durations:
Period Procedure Type Examples
0-day Minor procedures (no post-op) Endoscopies, biopsies
10-day Short recovery procedures Laceration repairs, cataract surgery
90-day Major surgeries Joint replacements, open surgeries
Key 2025 Global Surgery Changes
- New HCPCS Code G0559
Purpose: Bills for post-op visits by a different provider (not the original surgeon) without a formal transfer of care.
Applies to: Follow-up within the 90-day global period.
Why It Matters: Ensures proper reimbursement when another physician manages recovery.
- Stricter Modifier Requirements
Modifiers 54, 55, and 56 are now mandatory for splitting pre-op, surgical, and post-op care between providers.
Modifier 54 = Surgical care only
Modifier 55 = Post-op care only
Modifier 56 = Pre-op care only (must now include formal transfer documentation)
- OIG Scrutiny on Post-Op Visits
Medicare requires tracking post-op visits with CPT 99024 (non-billable, but mandatory for reporting).
Affected providers: Large groups (10+ practitioners) in FL, KY, LA, NV, NJ, ND, OH, OR, RI.
Risk: Incorrect reporting could lead to payment reductions.
What’s Included vs. Excluded in the Global Package
✅ Included (No Separate Billing)
Routine post-op visits
Incision care, suture removal
Pain management related to surgery
🚫 Excluded (Bill Separately)
Service Modifier Example
Unrelated E/M visit 24 Treating hypertension during a knee surgery’s global period
Same-day significant E/M 25 Pre-op evaluation revealing uncontrolled diabetes
Decision for surgery 57 ER visit leading to same-day appendectomy
Unrelated procedure 79 Treating a wrist fracture during a hip replacement’s recovery
Critical care (unrelated) FT Post-op heart attack management after gallbladder surgery
Avoid These Costly Global Surgery Mistakes
❌ Assuming Medicare is always primary (Check employment status for Medicare secondary cases).
❌ Billing post-op visits separately (Unless using G0559 or modifiers 55/79).
❌ Missing modifier requirements (New 2025 rules enforce 54/55/56 for split care).
❌ Failing to document transfer of care (Required for Modifier 56).
❌ Overlooking OIG reporting (Missing 99024 in required states risks penalties).
Best Practices for Compliance
✔ Verify global periods for each procedure (0, 10, or 90 days).
✔ Use modifiers correctly (24, 25, 54, 55, 56, 57, 58, 78, 79, FT).
✔ Track post-op visits (Report 99024 where mandated).
✔ Document transfers of care (Critical for Modifier 56).
✔ Stay updated on CMS changes (Review MPFS and OIG guidelines).
Need Help with Global Surgery Billing?
Quick Claim Med ensures:
🔹 Accurate modifier usage (Avoid denials & audits)
🔹 Full OIG/CMS compliance (Stay ahead of reporting rules)
🔹 Maximized reimbursements (Clean claims = faster payments)
📞 Contact us at [email protected] today for a free billing review and let our experts handle your global surgery coding!
