The Global Surgical Package in Medical Billing: 0, 10 and 90 Day Global Periods

The global surgical package is Medicare’s single payment for a surgery and the routine care that goes with it: the visits after the decision to operate, the operation, and the follow-up for a set number of days afterward. The number of days is the global period, and it is 0, 10 or 90 for almost every surgical code.

This rule affects every urology practice, because a cystoscopy, a vasectomy and a TURP each carry a different period. Once you know where the three numbers come from, the modifiers make sense.

Where you see it

Place	What it shows
Medicare Physician Fee Schedule RVU file, GLOB DAYS column	The global period indicator for every code: 000, 010, 090, XXX, YYY, ZZZ or MMM. Field 16 of the MPFSDB
RVU file, PRE OP, INTRA OP and POST OP columns	The share of the payment that belongs to each part of the package, used when care is split between physicians with modifiers 54, 55 and 56
CMS-1500 box 24D or 837P SV101	The modifier that explains why a visit or procedure inside a global period should be paid: 24, 25, 57, 58, 78 or 79
CMS-1500 box 24A	The date of surgery on the surgical line; the MAC uses it to run the global period edits on later claims
Remittance advice	CARC 97 with RARC M144 when a visit inside the period is bundled into the surgery

The indicators

The CMS relative value file (the October 2026 release is RVU26D) carries one of these values for every code.

Indicator	Meaning	Visits on the day	Follow-up visits
000	Endoscopy or minor procedure	Included in the procedure unless significant and separate (modifier 25)	Payable from the next day
010	Minor procedure	Included unless modifier 25 applies	Included for 10 days after the procedure (11 days in all)
090	Major surgery	Included, and so is the day before, except the decision-for-surgery visit (modifier 57)	Included for 90 days after surgery (92 days in all)
XXX	The global concept does not apply	Visits, labs, drugs and most medicine codes	None
YYY	Contractor priced; the MAC sets 0, 10 or 90 days	Depends on the MAC	Depends on the MAC
ZZZ	Add-on code, always billed with a primary code	Takes the global period of the primary code	Takes the primary code’s period
MMM	Maternity codes; the usual global rule does not apply

Urology examples, checked against the October 2026 RVU file:

Code	Service	Global	Pre, intra, post split
52000	Cystourethroscopy	000	none
52204	Cystourethroscopy with biopsy	000	none
52332	Cystourethroscopy with ureteral stent	000	none
51702, 51703	Bladder catheter insertion	000	none
52601	Transurethral resection of the prostate	090	8, 83, 9 percent
55250	Vasectomy	090	10, 80, 10 percent
50590	Lithotripsy, extracorporeal shock wave	090	8, 83, 9 percent
55866	Laparoscopic radical prostatectomy	090	8, 83, 9 percent
51728	Complex cystometrogram with voiding pressure	000	none
51797	Intra-abdominal voiding pressure, add-on	ZZZ	follows the primary code
99213, 99214	Office visits	XXX	none

Two things worth noticing. Office cystoscopy has no postoperative days at all, so a visit a week later for a different complaint is billed as a normal visit. And a vasectomy carries the same 90-day period as a radical prostatectomy, so the routine two-week check after a vasectomy is not billable.

When you count the days, the day of surgery is not day one. For a 090 code, the period is the day before surgery, the day of surgery and the 90 days after it: surgery on January 5 gives a preoperative day of January 4 and a last postoperative day of April 5. For a 010 code, count the day of the procedure and the next 10 days: January 5 to January 15. The MAC applies these edits to the surgeon and to every same-specialty physician in the group, who are treated as one physician for the package.

What is inside the package

The Medicare Claims Processing Manual, Chapter 12, section 40.1, lists the components. Included, when furnished by the surgeon or a same-specialty partner in the same group:

• preoperative visits after the decision to operate, starting the day before a major surgery or the day of a minor one;
• the intraoperative work itself;
• treatment of complications that do not need another trip to the operating room;
• follow-up visits related to recovery, and postsurgical pain management;
• supplies, other than specific exclusions; and
• routine care such as dressing changes, suture and staple removal, and insertion, irrigation and removal of urinary catheters and drains.

Paid separately: the initial evaluation that decides a major surgery is needed, visits unrelated to the surgical diagnosis, treatment of the underlying condition, diagnostic tests, clearly distinct procedures, return trips to the operating room for complications, critical care unrelated to the surgery, and immunosuppressive therapy after a transplant. For a minor procedure the initial evaluation is always inside the package.

The modifiers

Modifier	Use it when	Effect
57	A visit on the day before or the day of a 090 procedure leads to the initial decision to operate	Visit is paid; never used with 000 or 010 procedures
25	A significant, separately identifiable visit happens on the same day as a 000 or 010 procedure	Visit is paid in addition to the procedure; a different diagnosis is not required
24	The same physician sees the patient during the postoperative period for something unrelated to the surgery	Visit is paid; the diagnosis should show it is unrelated
58	A staged, planned or more extensive related procedure during the postoperative period, or therapy after a diagnostic procedure	Procedure is paid and a new global period starts
78	An unplanned return to the operating room for a related procedure, usually a complication	Procedure is paid; CMS pays only the intraoperative portion, and the original period continues
79	An unrelated procedure during the postoperative period	Procedure is paid and a new global period starts
54, 55, 56	The surgery and the postoperative care are split between physicians by a documented transfer of care	Each bills the surgical code with the modifier and is paid the matching percentage

An operating room, for modifier 78, means a place equipped and staffed solely for procedures, including an endoscopy suite. A treatment room in the office does not count. Taking a patient back to the office procedure room for a clot evacuation after a TURP is treated as a complication inside the package, not a modifier 78 return.

Worked example: a TURP and what follows

Dr. Okafor sees a 71-year-old patient on March 3 with urinary retention from an enlarged prostate and decides to perform a TURP. The national 2026 non-facility and facility amounts below are RVUs times the 33.4009 conversion factor, before geographic adjustment and sequestration, so treat them as illustrative.

Date	Service	Code and modifier	National amount	Why
March 3	Office visit, decision for surgery	99214-57	135.61	Decision visit the day before a 090 surgery is excluded from the package
March 4	TURP	52601	526.06	The global period runs March 3 to June 2, 92 days
March 18	Catheter removal and voiding trial	nothing billed	0.00	Routine postoperative care and catheter removal are inside the package
April 10	Visit for a kidney stone found on imaging, unrelated	99213-24	95.19	Unrelated to the TURP; the stone diagnosis supports the modifier
April 24	Cystoscopy with clot evacuation in the hospital endoscopy suite for bleeding	52001-78	intraoperative share only	A return to an operating room for a complication; the June 2 end date does not move
June 15	Six-month follow-up	99213	95.19	The period ended June 2, so the visit is billed with no modifier

Had the practice billed the March 18 visit as 99213, the MAC would have bundled it with CARC 97 and RARC M144. Had it billed the March 3 visit without modifier 57, the same edit would have bundled it, and the practice would have lost 135.61 for the visit where the decision to operate was made.

What to do

• Load the global indicator and the split percentages into your system. Both are free columns in the quarterly RVU file. A visit billed by the surgeon inside a 090 or 010 window should be held at charge entry until someone chooses 24, 58, 78 or 79 or confirms it is routine.
• Put the surgery date on every related line. The MAC matches later claims to the surgery by that date, and a split-care claim with 54 or 55 must show the date of surgery, not the visit date.
• Treat 000 codes differently from 010 and 090. Cystoscopy follow-up visits are payable from the next day, so there is no global modifier to add; the only question is modifier 25 on the day of the scope.
• Document why, not just which. Modifier 24 needs a diagnosis or note that shows the visit was unrelated. Modifier 58 needs a plan recorded before or at the first procedure.
• Denials to recognize: CARC 97 with M144 is a visit or service bundled into the surgery; correct and resubmit with the right modifier if one applies, otherwise write it off as part of the package. CARC 4 with N519 is a modifier the code cannot take, for example modifier 57 on a 000 procedure. CARC B20 means another physician was paid for the care, which usually points to a missing transfer of care agreement.
• Iridium Suite’s claim scrubber bundling edits flag a routine visit billed inside a global period, and the notes on the account record why an exception applies.

Related terms

• Modifier 26 and modifier TC
• Global, professional and technical charges
• Facility vs non-facility rates
• Place of service codes
• Medically Unlikely Edits
• CMS-1500 box by box

Further reading: CMS MLN booklet MLN907166, Global Surgery (December 2025); Medicare Claims Processing Manual, Chapter 12, sections 30.6.6 and 40 to 40.3; CMS PFS Relative Value Files (the GLOB DAYS and pre, intra and post columns); NCCI Policy Manual for Medicare Services, 2026, Chapter VII, urinary and male genital systems.