Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: December 31, 2019

Strategies for Improving Global Surgery Payment Accuracy

FAQ: Strategies for Improving Global Surgery Payment Accuracy (PDF) contains guidance regarding documentation and payment under the Medicare Physician Fee Schedule for visits with a global surgical package.

Data Collection on Resources Used in Furnishing Global Services

Medicare payment for most surgical procedures covers both the procedure and post-operative visits occurring within a global period of either 10 or 90 days following the procedure. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) mandated that CMS collect data on the number and level of post-operative visits furnished to patients and to use this information to improve the accuracy of global surgical package valuation. In response, beginning July 1, 2017, Medicare required select practitioners from nine states (Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island) to report on post-operative visits during global periods using a no-pay procedure code  following certain high volume or high cost procedures.   For more details on the reporting requirement, see 81 FR 80209.

Annual Lists of Procedure Codes for which Post-operative Visit Reporting is Required

• Global Reporting List 2025 (ZIP)
• PFS_Global_010_090_Reporting_PostOp_Visit_2024-2017_List_Archive.zip (ZIP) - Updated 01/29/2024

RAND Reports Related to Post-operative Visit Reporting and Global Surgical Packages

CMS contracted with RAND to develop reports related to post-operative visits furnished as part of global surgical packages. Several reports present descriptive statistics from claims-based reporting of post-operative visits, including measured “observed-to-expected” ratios comparing the share of visits currently considered by CMS when valuing global surgical services that were reported..

• RAND Report: “Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day; Global Periods - Updated Results Using Calendar Year 2019 Data (ZIP)” (2021).
• RAND Report: “Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods - Final Report (ZIP)” (2019: July 1, 2017 and June 30, 2018 data from nine states)
• RAND Report: “Survey-Based Reporting of Post-Operative Visits for Select Procedures with 10- or 90-Day Global Periods Final Report (PDF)” (2019)

RAND also developed reports modeling the implications of removing RVUs for post-operative visits not typically furnished to patients as part of global surgical packages on the valuation of surgical procedure codes.  This information is for consideration only.  Revaluing procedures with 10- and 90-day global periods resulted in substantial reductions in total RVUs across all Physician Fee Schedule services for proceduralist specialties and slight increases in RVUs for some other specialties.

• RAND Report:  “Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods:  Updated Results Using Calendar Year 2019 Data (PDF)” (2021)
• RAND Report: “Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods (PDF)” (2019)

G-codes

In the CY 2017 proposed rule, CMS proposed to use a set of no-pay G-codes to capture information on the number and level of post-operative services via claims. For more on this proposal see pages 46191 - 46200 of the CY 2017 proposed rule (CMS-1654-P). In making our proposal, we relied heavily upon codes developed for reporting post-operative care by RAND under a contract with CMS. Also, as part of this contract, RAND was required to test the G-codes that CMS proposed to assess whether practitioners understood the codes and could accurately apply them. RAND Report: “Testing New Codes to Capture Post-Operative Care” (2017) details the results of this testing.

• RAND Report: “Developing Codes to Capture Post-Operative Care (PDF)” (2016)
• RAND Report: “Testing New Codes to Capture Post-Operative Care (PDF)” (2017)
   

CMS References to Final Rules Concerning 10 and 90 Day Global Codes Involved with Post-operative data Collection

CMS is required to collect data to use in valuing global surgical services by Section 1848(c)(8)(B) of the Social Security Act. For more information on the data collection effort, we refer readers to pages 80209 - 80225 of the CY 2017 PFS final (CMS-1654-F).

In addition to this claims-based data collection, CMS has contracted with RAND to conduct a survey to collect additional data on pre- and post-operative services. For more information on the survey, we refer readers to pages 80222 - 80224 of the CY 2017 PFS final rule (CMS-1654-F).

For Further Information Contact MedicarePhysicianFeeSchedule@cms.hhs.gov

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