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Evaluation and Management Services
- Evaluation and Management Services
- General Principles of Medical Record Documentation
- What Should Be Provided if Medical Records Are Requested for Review?
- Hospital Inpatient or Observation Evaluation and Management Add-On Code G0545 for Infectious Diseases
- Office/Outpatient Evaluation and Management Visit Complexity Add-on Code G2211
- Related Resources
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FAQs
- Admission and Discharge Services
- Advanced Care Planning
- Behavioral/Mental Health Services
- Chronic Care Management
- Complex and Chronic Care - HCPCS Code G2211
- Consultations
- Critical Care Services
- Documentation
- Emergency Department
- Examination
- Fee-For-Time Compensation Arrangements
- General E/M Information
- Global Period Services
- History
- IPPE and AWV Services
- Medical Decision Making
- New vs. Established Patients
- Nonphysician Practitioner Services
- Observation Services
- Preoperative Clearance
- Prolonged Services
- Provider Specialty
- Scribes
- Separately Identifiable Service
- Skilled Nursing Facility Services
- Smoking Cessation
- Split/Shared and Incident To Services
- Teaching Environment E/M Services
- Telehealth Services
- Time-Based Services
- Transitional Care Management
- Urgent Care
- Related Articles
Global Period Services
- Is it permissible for providers (physicians or NPPs) other than the primary surgeon to bill for preoperative or postoperative care within a global period?
Answer: The global surgery fee is paid to the primary surgeon and includes compensation for standard elements of the surgery (pre, intra and postoperative care). In CY 2025, CMS approved HCPCS G0559 for use with E/M postoperative care services performed by a practitioner other than the primary surgeon. These other practitioners may include members of the primary surgeons group and also other providers who address surgically related issues during a 90-day global period. Prior use of modifier 54 (transfer of care) on the surgical claim by the primary surgeon is not obligatory in these circumstances.
- Please define which provider specialties may bill G0559?
Answer: There are no specific restrictions on provider specialties that may bill G0559. However, it is expected that G0559 will be billed by providers who are performing postoperative care relative to the surgery. Providers performing care for diagnoses unrelated to the surgery (e.g., cardiologist treating chronic hypertension) should not bill G0559 on such claims.
- Please define frequency limitations on G0559.
Answer: CMS expects that providers addressing postoperative surgical issues would bill G0559 once within a 90-day global period.
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How do global period rules apply to critical care services
Answer: Global surgery rules apply to the primary surgeon who performed and billed the surgical service that established the global period. When the primary surgeon performs a critical care service within the global period for a problem unrelated to the surgery, the surgeon bills the critical care service with modifiers 24 and FT. (Modifier FT is effective 1/1/2022 and required 3/1/2022).
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If a surgery/procedure is cancelled pre- or post anesthesia induction, can the surgeon bill an E/M based on the preoperative history, examination and plan that is documented, detailing why the surgery was cancelled?
Answer: When a surgical procedure is cancelled in this situation, the surgeon’s preoperative E/M service is no longer bundled into the surgical package and may be separately billed. If the surgery were to be performed later that same day, the E/M would again be bundled into the package.
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What constitutes “start of procedure” per CMS?
Answer: CMS considers surgical incision (or start of procedure if no incision required) as the start time for the procedure.
- What scenario/situation is appropriate for use of modifiers 24 and 25 on the same claim for an E/M service, e.g., 99212 24/25?
Answer: Modifier 24 describes an E/M service during a global period, unrelated to the procedure that established the global period, while modifier 25 describes a separately identifiable E/M service when a procedure is performed during the same encounter. The need for both of these modifiers on the same claim during a global period would be unusual; the following scenario is an example of a scenario in which both modifiers could be used:- A patient is seen by the operating surgeon for an office f/u mid-level visit, two weeks after a hemi-colectomy. During the visit, the patient presents with an infected abscess on the right shoulder. The provider addresses this unrelated problem and recommends a course of antibiotics. This service could appropriately be billed as 99213 24, since it is unrelated to the hemi-colectomy.
- If the provider scheduled the patient for a f/u visit for possible I&D of the abscess, and the patient presented with two additional abscesses that required further evaluation, billing for the second visit could include 99213 24/25, along with, along with CPT 23030 for the I&D.
Revised 4/21/2025