Navigating the financial landscape of medical procedures can be confusing. To simplify billing and standardize payment, organizations like the Centers for Medicare & Medicaid Services (CMS) developed the concept of the Global Time Period (GTP), often referred to as the Global Surgical Package (GSP). This framework bundles the payment for a procedure and all its related, routine follow-up care into a single fee. This prevents providers from billing separately for every visit during the recovery process. The goal is to provide a comprehensive payment covering the surgeon’s work before, during, and immediately after the operation.
Defining the Global Time Period
The Global Time Period (GTP) is a defined duration surrounding a surgical procedure during which all routine, related care is included in the initial payment. The length is determined by the procedure’s complexity, falling into three standardized categories: 0 days, 10 days, or 90 days. The 90-day period is reserved for major surgical operations requiring extensive recovery; it begins one day before the surgery and extends for 90 days after the procedure date. Minor procedures often fall under the shorter 0-day or 10-day global periods. Endoscopies typically have a 0-day global period because they are minimally invasive and do not require formal post-operative follow-up beyond the day of the procedure.
A 10-day period applies to other minor procedures, such as simple excisions or biopsies, encompassing the procedure day and the 10 days immediately following it. Unlike major surgery, minor procedures with a 10-day GTP do not include a pre-operative day in the bundle.
Services Included in the Global Package
The Global Surgical Package includes services considered a necessary part of the patient’s surgical care. This bundled care is categorized into three phases: pre-operative, intra-operative, and post-operative services. For major procedures, the package covers the single evaluation and management visit that takes place one day before or on the day of the surgery, after the decision to operate has been made.
The intra-operative component includes the procedure itself, along with inherent services like the administration of local anesthesia and necessary surgical supplies. Post-operative care covers all routine follow-up visits related to recovery within the defined global period. This includes routine wound checks, dressing changes, and the removal of sutures, staples, or drains. Management of complications that do not require the patient to return to the operating room is also included in the global fee.
Services Specifically Excluded and Billed Separately
While the Global Time Period bundles many services, several types of care are specifically excluded and can be billed separately. Treatment for any illness or injury entirely unrelated to the surgical procedure is not covered by the global fee. For example, a patient treated for a sinus infection during recovery would receive a separate bill for that visit.
Separate payment is also allowed for diagnostic tests and procedures not included in the surgical package. This includes X-rays, magnetic resonance imaging (MRIs), laboratory tests, and pathology services. If a complication requires an additional, distinct procedure or a return trip to the operating room, that second procedure is billable separately. Finally, the initial consultation to determine the need for a major surgery can be billed as a separate service, as it is distinct from the pre-operative work included in the package.