When a person undergoes major surgery, the financial aspect of medical care is often streamlined through the Surgical Global Package (SGP). This system bundles the payment for the operation, the immediate care surrounding it, and necessary follow-up visits into a single fee. Understanding this bundled payment model is important for patients, as it defines which services are covered by the surgeon’s fee and which may result in separate bills.
Defining the Surgical Global Package
The Surgical Global Package (SGP) is a payment policy that consolidates the reimbursement for a surgical procedure and all related services provided by the surgeon into one comprehensive fee. This bundling mechanism is primarily established by the Centers for Medicare & Medicaid Services (CMS) and is widely adopted by most private insurance carriers. The core purpose of the SGP is to simplify billing and ensure providers are paid consistently for the complete episode of surgical care.
The single payment covers the work done before, during, and after the operation for a defined period. This approach prevents the surgeon from billing separately for routine components of care, such as brief hospital visits or standard post-operative check-ups. Furthermore, the SGP requires that a surgeon and any other practitioner from the same group practice and specialty are treated as a single entity for billing purposes. This ensures that the global fee covers the collective work of the entire surgical team associated with the primary procedure.
The concept is applied to procedures based on their complexity and the anticipated recovery time. Each surgical code is assigned a global indicator that dictates the length of the bundled period. This standardization helps to prevent over- or under-payment for the typical range of services a patient requires following a procedure.
The Postoperative Time Frame for Major Surgery
For major surgical procedures, the established length of the global period is 90 days, often referred to as a “90-day global.” This extended period reflects the complex nature of the operation and the longer recovery time required after significant surgical intervention. The 90-day count for the post-operative phase begins the day after the surgery is performed.
The global package for major surgery actually encompasses the day of surgery and one pre-operative day, totaling 92 days of coverage. The pre-operative day allows for certain services, like a final history and physical exam, to be included in the bundled fee. The 90-day count for the post-operative phase begins the day after the surgery is performed.
This 90-day time frame distinguishes major surgeries from minor surgeries, which typically have a much shorter global period. Minor procedures are assigned either a 0-day or a 10-day global period, depending on the complexity. The distinction between a major and minor procedure is based on the intensity of the procedure and the anticipated resources needed for a full recovery.
Services Covered Within the Global Postoperative Period
The global fee for major surgery includes all routine and necessary services provided by the surgeon or their team during the 90-day post-operative period. This includes all routine follow-up visits related to the recovery, which are considered part of the surgeon’s work and cannot be billed separately.
The management of post-surgical pain is also covered, including the initial prescriptions and any necessary monitoring by the operating surgeon. Furthermore, the SGP includes essential, non-surgical services related to wound care. This covers miscellaneous items such as dressing changes, local incisional care, and the removal of external components like cutaneous sutures, staples, wires, or drains.
An important inclusion is the management of minor complications that arise during the 90-day period. The surgeon’s fee covers additional medical or surgical services required to treat complications, such as a wound infection, provided the treatment does not require the patient to return to the operating room. If the patient is admitted to a critical care unit, the surgeon’s visits are also included in the global fee, provided the critical care is related to the surgery.
Services Not Included in the Global Package
While the SGP is comprehensive, several specific categories of services are explicitly excluded and can be billed separately, even if they occur within the 90-day post-operative period. The initial consultation or evaluation that leads to the decision for surgery is one such exclusion, as it is considered a distinct service from the procedure itself.
Diagnostic tests and procedures are never included in the global package. This means that any imaging, such as X-rays, CT scans, or laboratory work required during the recovery period, is billed separately by the facility or the performing provider. Furthermore, any treatment for complications that requires the patient to return to the operating room is excluded from the bundled fee.
Care provided by other physicians for conditions unrelated to the surgery is also excluded. For example, if a patient is recovering from a hip replacement and requires a visit to a cardiologist for a pre-existing heart condition, the cardiologist’s service is billed separately. Similarly, any distinct surgical procedures performed during the global period that are not a re-operation or complication treatment can be billed separately.