Global Surgical Package

The global surgical package is the set of services a surgeon's fee already covers when they bill a surgical CPT code. It includes the operation itself, the visit the day before or the day of surgery, and the routine follow-up care afterward for a set number of days. Medicare defines three global periods: 0 days for minor procedures, 10 days for small ones like a skin lesion removal, and 90 days for major surgery such as a joint replacement or a hysterectomy. Most commercial plans follow the same rules.

What this means in real life: if your surgeon replaces your hip on March 1, the office visits to check the incision, remove staples and review your progress through the end of May are already paid for inside the surgical fee. A separate office-visit bill for a routine post-op check in April is a billing error, and it is a common one. I've seen a $150 "established patient visit" show up six weeks after a surgery and get paid by the plan without anyone noticing. The global package does not cover everything, though. Treating a complication that requires a return to the operating room, care for an unrelated problem, or a visit that turns into a new diagnosis can be billed separately, and those are legitimate.

The takeaway: after surgery, look at every bill dated inside the global period. A routine follow-up visit billed separately within 90 days of major surgery should be questioned in writing, and the plan should recover the payment.