Guides Specialty billing

Global surgery period billing: what’s included and modifiers 24, 25, 57 and 79

By Marlow’s billing manager, 20+ years in medical billing, former billing manager at Mount Sinai South Nassau, Oceanside · Updated November 9, 2026 · 8 min read

The short answer

A procedure’s global period bundles the routine care before and after it into one payment, so related visits in that window are not billed separately. Care outside the package is billed with the modifier that says why, and from January 1, 2027 Medicare pays the lower-valued of a same-day office visit and 0-day procedure at 80%.

Most surgical procedures carry a global period: a window of 0, 10 or 90 days during which Medicare’s payment for the procedure also covers the routine care around it. Visits for normal recovery inside that window are not billed separately. Care that falls outside the package (an unrelated problem, a new procedure, a return to the operating room, or the visit where the decision to do major surgery is made) is billed with a modifier that tells the payer which exception applies.

This guide explains the three global periods, what the package includes and excludes, the modifiers that go with each exception, how care is split when another clinician takes over, the 99024 tracking code, and two changes that start January 1, 2027. It describes Medicare’s rules as of November 2026. Commercial plans often follow the same structure but can differ, so check each plan’s policy.

The three global periods

Every procedure code’s global period is listed in the “GLOB DAYS” column of CMS’s physician fee schedule relative value file (and in Addendum B of each year’s final rule). You can also see it in CMS’s fee schedule look-up tool.

Global indicator	Pre-op days included	Post-op days included	Total window	Same-day E/M
000 (endoscopies, some minor procedures)	None	None (only the day of the procedure)	1 day	Generally included. A significant, separately identifiable visit is billed with modifier 25. From 2027, Medicare pays the lower-paid service at 80%
010 (other minor procedures)	None	10 days after	11 days	Generally included. A significant, separately identifiable visit is billed with modifier 25
090 (major procedures)	The day before	90 days after	92 days	Included, except the visit where the decision to operate is made (modifier 57)
XXX	Global rules don’t apply
ZZZ (add-on codes)	Takes the global period of the primary procedure
YYY	The Medicare contractor sets the period

Source: CMS MLN Global Surgery booklet (MLN907166, December 2025).

What the global package includes

Per the Medicare Claims Processing Manual (chapter 12, §40.1) and the MLN booklet, the payment for a procedure with a global period covers:

pre-operative visits after the decision to operate (for major procedures, from the day before; for minor procedures, on the day of the procedure)
the usual intra-operative services
follow-up visits during the recovery period
treatment of complications that does not need a return to the operating room
post-operative pain management by the surgeon
supplies, except listed exclusions
routine items such as dressing changes, local incision care, and removal of sutures, staples, drains, casts and splints

It also applies to the whole group: clinicians in the same group practice and the same specialty bill and are paid as if they were one physician. A follow-up by the surgeon’s same-specialty partner is still inside the package.

What it does not include

These are separately payable:

the visit where the decision to perform a major procedure is made, on the day before or the day of surgery
visits for problems unrelated to the procedure
treatment of the underlying condition, or a new course of treatment that is not part of normal recovery
diagnostic tests and procedures
a separate procedure during the global period that is not a re-operation or treatment of a complication (it starts its own global period)
treatment of a complication that needs a return to the operating room
a more extensive procedure when a less extensive one fails
critical care unrelated to the surgery, for a critically ill or injured patient

For minor procedures, the decision to do the procedure is always part of the package, and so is the first evaluation. A separate visit on the same day needs to be significant and separately identifiable beyond that decision.

The modifiers

Each modifier states one reason the service falls outside the package. The note has to support that reason. The examples below are generic illustrations of the categories, not coding advice for any patient.

Modifier	What it says	Generic example of the category
24	Unrelated E/M visit by the same clinician during a post-op period	A patient in a 90-day global after knee surgery is seen for an unrelated problem. Medicare requires documentation that the visit is unrelated
25	Significant, separately identifiable E/M on the same day as a procedure	A problem is evaluated beyond the work of a same-day minor procedure
57	E/M that resulted in the decision for major surgery, the day before or the day of	The visit where the decision to perform a 90-day procedure is made. Not used with 0 or 10-day procedures
58	Staged or related procedure during the post-op period	A second stage planned at the time of the first, a more extensive procedure, or therapy after a diagnostic procedure. Starts a new global period
78	Unplanned return to the operating or procedure room for a related procedure	A complication that needs a return to the OR. Medicare pays only the intra-operative portion of the code (full value for a 0-day code)
79	Unrelated procedure by the same clinician during the post-op period	A different procedure for a new problem. Starts a new global period

When a significant, separately identifiable visit happens on the day of a procedure that also falls inside the post-op period of an earlier, unrelated procedure, the MLN booklet says to use both 24 and 25.

Medicare does not require different diagnoses for a modifier 25 visit on the same day as a procedure. Medicare contractors can add prepayment screens or documentation requirements for clinicians whose modifier 25 or 57 use is high after review (Claims Processing Manual, chapter 12, §30.6.6).

For more on modifier 25, see our modifier 25 guide.

When another clinician does part of the care

Formal transfer of care: modifiers 54, 55 and 56

When the surgeon and another clinician agree that the other clinician will do part of the global care, both bill the same procedure code and date of service with a modifier:

54, surgical care only (the surgeon). Medicare’s current guidance says 54 is used any time a clinician plans to do only part of the package, including an expected transfer that was never written down.
55, post-operative management only (the clinician taking over). Used with 10 and 90-day procedures. The clinician must see the patient at least once before billing, and both clinicians keep a copy of the written transfer agreement in the record.
56, pre-operative care only.

Split global billing does not apply to 0-day procedures. Together, the pieces cannot pay more than the full global amount.

No transfer of care: G0559

When there is no transfer and a clinician who did not do the surgery (and is not in the surgeon’s group) sees the patient for a post-operative follow-up, that clinician bills the E/M visit with no global modifier. Medicare also has an add-on code, G0559, for the extra time and resources in that follow-up visit. It remains active for 2027 in CMS’s final rule files.

A clinician managing an underlying condition during someone else’s global period, such as a cardiologist managing a heart condition after orthopedic surgery, bills the E/M visit without a modifier.

99024: the no-pay post-op code

CPT 99024 reports a post-operative visit that is included in the global package. It has no payment. It exists so the visit can be tracked.

Under section 523 of MACRA, Medicare required 99024 reporting only from practices with 10 or more practitioners in nine states (Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island), for a set list of procedures. New York was not one of them. For 2027, CMS is pausing this data collection altogether.

That does not make 99024 useless. Some practices use it to count post-op visits for their own scheduling and productivity reports. Check whether any of your plans’ policies ask for it.

CMS has said its data show many post-operative visits paid for in 10 and 90-day packages are not happening. It took comments on how to revalue 10 and 90-day packages and said it may use them in future rulemaking.

What changes on January 1, 2027

Same-day visit with a 0-day procedure. When an office visit with modifier 25 and a 0-day global procedure happen the same day, by the same clinician or a same-specialty clinician in the same group, Medicare pays the higher-paid service in full and the other at 80%. CMS had proposed a 50% cut covering 10 and 90-day procedures too, and narrowed it to 20% and 0-day procedures in the final rule.
99024 data collection paused. See above.

Both are in the 2027 Physician Fee Schedule final rule, published in the Federal Register on November 9, 2026.

Where global periods go wrong

Same-specialty partners. A follow-up by a partner in the same specialty is inside the package. A partner in a different specialty is not bound by it.
Modifier 79 vs 58 vs 78. 79 and 58 start a new global period. 78 is paid at the intra-operative portion only. Billing the wrong one changes both the payment and the end date of the window you track.
Modifier 57 on minor procedures. Medicare does not pay it with 0 or 10-day procedures.
Lost track of the window. A 90-day global runs 92 days counting the day before and the day of surgery. A practice management system that flags visits inside an open global period helps catch these before the claim goes out.
Transfer paperwork. Without a written transfer agreement in both records, a modifier 55 claim is hard to defend.

Sources

General information, not advice on a specific claim, contract or legal question. Rules and rates change; check the linked sources for the current version. CPT® is a registered trademark of the American Medical Association. Code descriptions here are paraphrased.