Medicare Global Surgery Payment Rules

Tuesday, January 18, 2011  
FROM:  Valerie Palladino
TO:  All Providers
DATE:  01/18/2011
SUBJECT:  Medicare Global Surgery Payment Rules

Please be reminded that Medicare has specific billing and payment rules regarding major and minor surgical procedures. Surgery codes that carry a 90 day aftercare period (surgical O.R. cases, fracture care, etc.) are considered major and those that carry a 10 day aftercare period (injections, debridement, etc.) are considered minor.

The Medicare payment for a major surgery includes payment for any visit the day PRIOR to the surgery as well as visits within the 90 days following surgery. If you see a patient the day before a major PLANNED procedure Medicare should not be billed and will not reimburse this visit as the payment is included in the surgical reimbursement. Medicare will pay a visit prior to surgery ONLY when the visit IS the decision for surgery and in these cases modifier 57 is required.
The Medicare payment for minor procedures includes payment for the visit the day of the surgery and visits within 10 days following the procedure.

Please keep these billing and payment rules in mind as you treat your Medicare surgical population. If you have any questions, please do not hesitate to contact me at (845)-363-4828 or vpalladino@mmcoa.com.

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