Global surgical package means the group of services Medicare pays for with one surgical fee: related preoperative visits, the procedure itself, and routine postoperative care during a global period of 0, 10 or 90 days. Related visits and services inside that window aren’t billed separately unless an exception applies, usually shown with a modifier.

Medically Unlikely Edits (MUEs) are CMS limits on the units of service Medicare will pay for one HCPCS or CPT code billed by the same provider for the same patient on the same date of service. If a claim line or date exceeds the limit, Medicare denies all units for that code on that line or date.

Modifier 24 is the CPT modifier added to an evaluation and management (E/M) code when the surgeon, or a same-specialty physician in the same group, sees a patient during a procedure’s postoperative global period for a problem unrelated to that surgery. It tells the payer the visit is not routine postoperative care already included in the surgical payment.

Modifier 25 is the CPT modifier appended to an evaluation and management (E/M) code to show that, on the same day as a procedure, the same physician provided a significant, separately identifiable E/M service beyond the procedure’s usual pre- and post-procedure work. In orthopedics it most often appears on joint injection, casting and other minor-procedure days.

Modifier 57 is the CPT modifier added to an evaluation and management (E/M) code when that visit, on the day of or the day before a major procedure with a 90-day global period, results in the initial decision to perform the surgery. It separates the decision visit from preoperative care that is already included in the surgical payment.

Modifier 58 is the CPT modifier for a procedure performed by the same physician during another procedure’s postoperative period when the second procedure was planned at the time of the first, is more extensive than the first, or is therapy following a diagnostic procedure. Medicare pays it separately, and a new global period begins with it.

Modifier 59 and X{EPSU} modifiers means the group of modifiers that tells a payer two procedures normally bundled by an NCCI procedure-to-procedure edit were distinct: modifier 59 (distinct procedural service) and its four more specific HCPCS subsets, XE (separate encounter), XS (separate structure), XP (separate practitioner) and XU (unusual non-overlapping service).

Modifier 78 is the CPT modifier for an unplanned return to the operating or procedure room by the same physician, during a procedure’s postoperative period, for a related procedure such as treating a complication. Medicare generally pays only the intraoperative portion of the return procedure, and no new global period begins; the original one keeps running.

Modifier 79 is the CPT modifier for a procedure performed by the same physician during another procedure’s postoperative period when the new procedure is unrelated to the original surgery. Medicare pays the unrelated procedure separately, and a new global period begins with it, so its own follow-up care is then included in its payment.

NCCI procedure-to-procedure (PTP) edits are CMS code-pair edits that stop Medicare from paying for two services that generally shouldn’t be reported together by the same provider for the same patient on the same date. When both codes are billed, the column one code pays and the column two code is denied unless an allowed modifier fits.