Document the anatomic site, laterality and timing in the operative note. | Audit 59 and X modifier use by surgeon on a regular schedule. |
Unrelated procedure during the postoperative period; a new global period starts | 79 |
Orthopedic example
Total knee replacement (27447, global 090). A routine preoperative visit the day before surgery, hospital visits, staple removal and follow-up through day 90 are included. A return to the operating room in week three to wash out a postoperative infection is reported with modifier 78. An E/M for a new, unrelated shoulder problem in week six carries modifier 24 with a diagnosis showing it’s unrelated.
Distal radius fracture (25605, global 090). The surgeon evaluates a new fracture and decides on closed reduction the same day, so that E/M can carry modifier 57. The fracture code includes the initial cast, so the surgeon doesn’t bill a casting code. Under NCCI policy, a physician who only applies an initial cast or splint, without definitive treatment or planned follow-up, may report an E/M, the casting code and a cast supply code (Q4001–Q4051).
Common denial triggers
An E/M inside a global period billed without modifier 24, 25, 57 or FT. Once the surgery claim has been adjudicated, Medicare remits these as group code CO with CARC 97.
Modifier 57 on an E/M before a 000- or 010-day procedure.
A second procedure in the postoperative period billed without 58, 78 or 79.
Modifier 24 on routine postoperative follow-up, or without documentation that the visit was unrelated.
A casting code billed with fracture treatment by the same surgeon.
How to prevent or fix
Look up the global indicator for each surgical code and flag open global periods in your scheduling or billing system.
Document the decision for surgery in E/M notes billed with 57, and the unrelated diagnosis for 24.
Choose by relationship: planned or more extensive (58), complication needing the operating room (78), unrelated (79).
Record related postoperative visits with 99024, the no-charge code for visits inside a global period. Groups of 10 or more practitioners in nine states (FL, KY, LA, NV, NJ, ND, OH, OR, RI) must report them for listed procedures.
For same-day E/M with injections, see our guide to modifier 25 on orthopedic injection days.
Why it matters in orthopedics
In CMS’s 2026 fee schedule data, total knee and hip replacement (27447, 27130), knee arthroscopy with meniscectomy (29881), arthroscopic rotator cuff repair (29827) and closed distal radius fracture treatment (25600, 25605) all carry 090. Major-joint injections (20610) and cast or splint applications carry 000. Knowing which window is open prevents billing visits Medicare already paid for and missing services it pays separately.
How it works
Every physician fee schedule code carries a global surgery indicator, shown in the PFS Look-Up Tool and fee schedule data files:
Indicator | What it means |
|---|---|
000 | Endoscopy or minor procedure; covers the procedure day only |
010 | Minor procedure; the procedure day plus 10 days (11 days total) |
090 | Major surgery; the day before, the day of surgery and 90 days after (92 days total) |
XXX | The global concept doesn’t apply |
YYY | Contractor-priced; the MAC sets a 0-, 10- or 90-day period |
ZZZ | Add-on code; follows the global period of the primary procedure |
MMM | Maternity procedure |
For the surgeon, and same-specialty colleagues in the same group, the payment includes:
preoperative visits after the decision to operate, starting the day before surgery for major procedures and the day of surgery for minor ones;
the usual intraoperative work;
treatment of complications that don’t require a return to the operating room;
routine postoperative visits, postsurgical pain management by the surgeon, supplies, and services such as dressing changes and removal of sutures, staples, casts and splints.
Diagnostic tests, treatment of the underlying condition, and these modifier situations are paid separately:
Situation | Modifier |
|---|---|
E/M on the day before or day of a 090 surgery that results in the initial decision to operate | |
Significant, separately identifiable E/M on the day of a minor procedure | 25 |
Unrelated E/M during the postoperative period | |
Staged, planned or more extensive related procedure; a new global period starts | 58 |
Unplanned return to the operating or procedure room for a related procedure; Medicare pays the intraoperative portion | |
Unrelated procedure during the postoperative period; a new global period starts | 79 |
Orthopedic example
Total knee replacement (27447, global 090). A routine preoperative visit the day before surgery, hospital visits, staple removal and follow-up through day 90 are included. A return to the operating room in week three to wash out a postoperative infection is reported with modifier 78. An E/M for a new, unrelated shoulder problem in week six carries modifier 24 with a diagnosis showing it’s unrelated.
Distal radius fracture (25605, global 090). The surgeon evaluates a new fracture and decides on closed reduction the same day, so that E/M can carry modifier 57. The fracture code includes the initial cast, so the surgeon doesn’t bill a casting code. Under NCCI policy, a physician who only applies an initial cast or splint, without definitive treatment or planned follow-up, may report an E/M, the casting code and a cast supply code (Q4001–Q4051).
Common denial triggers
An E/M inside a global period billed without modifier 24, 25, 57 or FT. Once the surgery claim has been adjudicated, Medicare remits these as group code CO with CARC 97.
Modifier 57 on an E/M before a 000- or 010-day procedure.
A second procedure in the postoperative period billed without 58, 78 or 79.
Modifier 24 on routine postoperative follow-up, or without documentation that the visit was unrelated.
A casting code billed with fracture treatment by the same surgeon.
How to prevent or fix
Look up the global indicator for each surgical code and flag open global periods in your scheduling or billing system.
Document the decision for surgery in E/M notes billed with 57, and the unrelated diagnosis for 24.
Choose by relationship: planned or more extensive (58), complication needing the operating room (78), unrelated (79).
Record related postoperative visits with 99024, the no-charge code for visits inside a global period. Groups of 10 or more practitioners in nine states (FL, KY, LA, NV, NJ, ND, OH, OR, RI) must report them for listed procedures.
For same-day E/M with injections, see our guide to modifier 25 on orthopedic injection days.
Frequently asked questions
When does a 90-day global period start and end?
Medicare counts the day before surgery, the day of surgery and the 90 days after, for 92 days in total. For example, surgery on January 5 has a global period from January 4 through April 5. For 10-day procedures, count the day of the procedure plus the next 10 days. Procedures with a 000 indicator cover only the day of the procedure.
Can another surgeon in the same group bill a postoperative visit?
Not for routine postoperative care. Medicare treats physicians of the same specialty in the same group as a single physician for global surgery, so their related postoperative visits are part of the package. A physician of a different specialty managing an underlying condition, such as a cardiologist, bills an E/M without a modifier. A formal transfer of care uses modifiers 54 and 55.
Do commercial and workers’ comp payers use Medicare’s global days?
Not automatically. Commercial payers set their own surgical package policies, and workers’ compensation fee schedules decide which Medicare rules they adopt. Texas, for example, applies Medicare payment policies to non-network professional services. Check the payer’s published policy or the state fee schedule ground rules before assuming Medicare’s 0-, 10- or 90-day periods apply.
Guides that cover this term
Related terms
Sources
Medicare Claims Processing Manual, Chapter 12 - Physicians/Nonphysician Practitioners (Section 40, Surgeons and Global Surgery) — CMS, chapter Rev. 13753 issued May 7, 2026; section 40.1 effective January 1, 2022
Global Surgery (MLN907166) — CMS Medicare Learning Network, December 2025
PFS Relative Value Files — CMS, RVU26D (October 2026 release)
Indicators for 2026 — CMS Medicare Physician Fee Schedule data, modified October 1, 2026
Chapter 4 - Surgery: Musculoskeletal System CPT Codes 20000-29999 — CMS Medicare NCCI Policy Manual, revision date January 1, 2026
2026 Professional and Workers’ Compensation Specific Exams Reimbursement Rates — Texas Department of Insurance, Division of Workers’ Compensation, updated January 15, 2026
This entry is educational and is not legal, coding-compliance or billing advice. Payer rules change often, so confirm requirements with the payer before you bill. CPT® is a registered trademark of the American Medical Association; code descriptions here are Rette’s plain-language summaries.