The Global Surgical Package (GSP) is a standardized method used in health care billing that bundles payment for a surgical procedure and all routine, related services provided by the surgeon. This approach creates a single fee for the entire episode of care, simplifying the billing process for providers and patients. Defined by the Centers for Medicare and Medicaid Services (CMS), the GSP has been widely adopted by most private insurance payers. Its purpose is to prevent the fragmentation of care and associated billing.
The Core Concept and Duration of the Package
The structure of the Global Surgical Package is determined by the complexity of the procedure, which dictates the length of the post-operative recovery period covered by the bundled payment. This defined timeframe, known as the “global period,” begins either the day before or the day of the surgery and includes all subsequent related care provided by the surgeon or their practice. Procedures are categorized into three types based on the duration of this global period, following CMS guidelines.
The shortest global period is zero days, which applies to many minor procedures, such as endoscopies. This includes no pre-operative or post-operative days, meaning only the procedure itself is covered. Other minor procedures carry a 10-day global period, which includes the day of the surgery and the ten days immediately following it, totaling an 11-day package. Neither of these minor categories includes a pre-operative period.
The most extensive category, covering major surgical procedures, has a 90-day global period. For these operations, the package begins one day prior to the surgery, includes the day of the procedure, and extends for the full 90 days afterward, resulting in a 92-day service bundle. The length of the global period determines which pre- and post-operative services are automatically included in the surgeon’s single fee.
Services Included Across the Surgical Phases
The Global Surgical Package is built around three phases of care—preoperative, intraoperative, and postoperative—and includes all the routine services performed by the surgeon within the defined global period that are related to the original diagnosis.
Preoperative Phase
During the preoperative phase for a major procedure (90-day global), this includes any necessary evaluation and management (E/M) services starting the day before the surgery, provided the decision to operate has already been made. For minor procedures (10-day global), the included E/M services begin on the day of the surgery itself. These included visits cover the final preparation and assessment of the patient before the operation.
Intraoperative Phase
The intraoperative phase includes the full surgical procedure as described by the specific Current Procedural Terminology (CPT) code. It also covers immediate, routine care provided by the surgeon, such as writing operative notes and evaluating the patient in the post-anesthesia recovery area. The package covers specific types of local anesthesia administered by the surgeon (e.g., local infiltration, digital blocks, or topical anesthesia), which are considered a routine part of the operation.
Postoperative Phase
The postoperative phase covers all necessary follow-up visits related to the patient’s recovery during the entire 10- or 90-day global period. This includes routine wound care, such as dressing changes and the removal of sutures or staples. The bundled payment also accounts for the surgeon’s management of typical, uncomplicated post-surgical pain and any additional services required due to a complication, provided the complication does not require a return trip to the operating room. All included services must be directly related to the original surgical diagnosis.
Services Always Billed Separately
Certain services are always excluded from the bundled payment and must be billed separately. The initial consultation or evaluation by the surgeon to determine the necessity of a major surgery is not included in the package and is billed separately.
The professional fee for general or regional anesthesia administered by an anesthesiologist or certified registered nurse anesthetist is always billed separately from the surgeon’s fee. Since the GSP covers only the surgeon’s professional services, hospital facility fees are excluded. These fees cover the operating room, recovery room, and supplies provided by the hospital.
Any diagnostic tests, such as laboratory work, X-rays, or imaging studies, are excluded and billed individually. Care for any unrelated medical conditions or new diagnoses that arise during the global period must be billed separately. If a patient develops a complication that necessitates an unexpected return to the operating room for a second procedure, that subsequent operation is billed outside of the original global package.