A follow-up visit after surgery: what the 0, 10 and 90 day global period lets a clinic bill

The part of the fee that pays for all the follow-up care is smaller than it looks. For an inguinal hernia repair (CPT 49505) the Medicare fee schedule amount in the facility setting is $548.69, and 10 percent of it, $54.87, is the portion the fee file assigns to post-operative care provided in the office after discharge. A single established-patient office visit, CPT 99213, carries an office amount of $95.55. That comparison is between two published amounts only, because the file does not say how many visits the post-operative share is meant to cover. It is still the reason a separate visit charge inside the window draws scrutiny: the manual calls a separate charge for a package service fragmented billing, and says the contractor does not pay more than the global amount when a bill is fragmented.

Counting the 0, 11 and 92 day windows

The fee schedule file gives every surgical code a global indicator, and the Medicare booklet on global surgery (MLN907166, December 2025) sorts them into three packages. A 000 code has no pre-operative period and no post-operative days, and a visit on the procedure day is generally not payable as a separate service. A 010 code has no pre-operative period and a total window of 11 days: the surgery day and the 10 days after it. A 090 code includes one day before surgery, the surgery day and the 90 days after it, 92 days in all. The claims manual (chapter 12, section 40.1) shows the count with its own dates: for a major operation on January 5 the pre-operative day is January 4 and the last post-operative day is April 5; for a minor procedure with 10 follow-up days on January 5 the last day is January 15.

Take a hernia repair on Tuesday, March 3, 2026. The package opens on March 2, 2026 and closes on June 1, 2026, so the first day outside it is June 2, 2026. A minor procedure with a 10-day window done on Tuesday, October 6, 2026, closes on October 16, 2026, and October 17, 2026 is outside. The count runs in days from the date of surgery printed on the claim, which is why every claim tied to the operation, including a transfer-of-care claim from another physician, carries that same date.

Show the numbers behind this figure

Global indicator	First day in the package	Last day in the package	Days counted
000	Day 0	Day 0	1 (no post-operative days)
010	Day 0	Day 10	11
090	Day -1	Day 90	92

The window follows the physician, not the building or the bill's header. The booklet states that global surgery applies in any setting, including an inpatient hospital, outpatient hospital, ambulatory surgical center and physician's office, and that a surgeon's visits to a patient in an intensive care or critical care unit are included. It also says the package covers services by the surgeon or by members of the same group with the same specialty, and that providers in the same group practice with the same specialty must bill and accept payment as though they were a single physician. A name that is new to the patient but belongs to the surgeon's partner in the same specialty is inside the same package.

Fifteen operations and their windows

The October 2026 relative value file lists 1,176 active codes with a 000 global period, 459 with 010 and 3,719 with 090. The table below prices fifteen of them in Detroit, Michigan Locality 01 ($33.4009 conversion factor, work, practice expense and malpractice geographic indexes of 1.000, 0.965 and 1.686). Where a code has both an office and a facility amount the table shows both; five of the six 90-day operations have a facility amount only, because the file marks them as rarely or never performed in an office. All of these are the surgeon's professional fee. The hospital or surgery center bills a separate facility fee, which the outpatient procedure guide and the surgery center versus hospital comparison price.

Source: CMS Physician Fee Schedule relative value file PPRRVU2026_Oct_nonQPP (released 08/26/2026, inside rvu26d-updated-08-26-2026.zip) and GPCI2026, Detroit, Michigan Locality 01, CY2026, $33.4009 conversion factor; global indicators from the GLOB DAYS column, windows from MLN907166. Computed November 3, 2026. Medicare anchors, not your bill. "None" means the file shows no payment amount in that setting.

Window length and price are separate things. The three 000 codes with office amounts above $100 are the colonoscopy at $378.46, the EGD with biopsy at $413.41 and the simple repair at $115.20, all with no follow-up period, while the six 90-day operations run from $437.89 for carpal tunnel release to $1,237.92 for a knee replacement. What a longer window changes is how much of the fee is already spoken for. The stitches guide prices the repair ladder, including why a 2 cm repair (12001) has no follow-up days built in while a 6 cm intermediate repair (12032) has ten, and the cortisone shot guide covers the 000-day injection code 20610 and why a visit on the same day needs its own justification.

Three other global indicators appear on bills. A ZZZ code is an add-on that is always billed with another service and takes the global period of the primary code, with no post-operative work of its own. A YYY code is priced by the Medicare contractor, which decides whether a global period applies and sets it at 0, 10 or 90 days. An XXX code, which includes the office visit codes themselves, is one where the global concept does not apply. The procedure pages for colonoscopy, EGD with biopsy, cataract surgery, carpal tunnel release and knee arthroscopy show the other layers of each bill.

What the fee already includes, and what CMS says about use

The list of what sits inside the surgeon's amount, which includes the post-operative visits, pain management, supplies and the dressing, suture and drain removal that make up routine recovery care, is set out in the assistant surgeon guide and is not repeated here. The question for a follow-up bill is a narrower one: how much of the fee is meant for the follow-up, and how often does it get used.

The fee file answers the first part with three percentages per code. For the 090 operations in this guide the post-operative share ranges from 10 percent to 21 percent, and for the 010 procedures it is 10 percent. On the total knee replacement (27447) the 21 percent post-operative share of $1,237.92 is $259.96. On the hernia repair it is $54.87. The file describes the post-operative percentage as the portion of the package provided in the office after discharge from the hospital, and the intra-operative percentage as including post-operative work in the hospital. Those are the amounts set aside for recovery care, and they are what a clinic would be collecting a second time if it billed an ordinary recovery visit on top.

The second part is in the CY2027 proposed rule for the physician fee schedule (91 FR 43842, July 16, 2026). CMS restates findings it first released in the CY2019 final rule: "only 4 percent of reviewed 10-day globals and 67 percent of reviewed 90-day globals had one or more post-operative visit which occurred during the global period." CMS adds that it believes the data show "how these visits are not occurring, yet providers are still being paid for these visits under the current global payment policy." That is CMS's stated view of a program-wide pattern, not a statement about any patient's recovery. A pattern of fewer visits does not make a billed one legitimate; the modifiers below do.

A decision rule for the follow-up visit on your bill

Medicare's claims manual builds the rule from the visit's relationship to the surgery, not from who performed it or how long it lasted. Go through these questions in order for each visit line, using the date of surgery and the code's global indicator from the first table.

Sources: Medicare Claims Processing Manual chapter 12, sections 40.1, 40.2.A, 40.3.B and 40.4.A; CMS MLN907166 (December 2025). Checked November 3, 2026. This is Medicare's rule; a plan other than Medicare follows its own policy.

Modifier 24 carries the strictest wording in the manual. Section 40.4.A of chapter 12 says, with the two exceptions bulleted in the original: "Modifier '-24' or '-FT' is intended for use with services that are absolutely unrelated to the surgery. It is not to be used for the medical management of a patient by the surgeon following surgery. Recognize modifier '-24' only for care following discharge unless: The care is for immunotherapy management furnished by the transplant surgeon; The documentation demonstrates that the visit occurred during a subsequent hospitalization and the diagnosis supports the fact that it is unrelated to the original surgery." Section 40.2.A.7 adds that a diagnosis code that clearly indicates the reason for the encounter was unrelated to the surgery is acceptable documentation. The practical reading is that a -24 line should carry a diagnosis that has nothing to do with the operation. A -24 line whose diagnosis is the surgical condition, or the wound, is the mismatch to question.

Modifier 57 is limited by the same manual. The first evaluation that results in the decision to operate is outside the package for major surgery, on the day before or the day of surgery, and the manual and the booklet say it is not used with minor surgery because a minor procedure's package does not include the day before; for a minor procedure the decision visit is a routine pre-operative service. A visit weeks earlier does not need the modifier at all, since it falls before the package begins. Modifier 25 handles a different case: a significant, separately identifiable visit on the day of a procedure, except the decision visit on the day of a major operation, which takes modifier 57. Where an operation with a 000 or 010 code and a visit share a date, the visit is billable only if the record supports a significant, separately identifiable service. The manual's example is a full neurological examination for a patient with head trauma, billable beside the suturing of a scalp wound, while billing a visit would not be appropriate if the physician only identified the need for sutures and confirmed allergy and immunization status.

Two further categories matter for a patient reading a bill. The manual excludes diagnostic tests and procedures, including diagnostic radiology, from the package, so a scan or lab test ordered during recovery can legitimately appear as its own line. Critical care (CPT 99291 and 99292) unrelated to the surgery, such as for a seriously injured or burned patient, is payable separately, and the manual and the booklet's exclusions list name modifier FT for it after surgery; the booklet's critical care section names modifiers 25 and 24 instead, and requires a diagnosis code showing the critical care was unrelated. The first test of any of these exclusions is the same as for modifier 24: the paperwork has to show it was not about the operation.

Transfer of care: modifiers 54, 55 and 56

When one physician operates and another provides the recovery care, the single fee is split, and the percentages are in the same fee file. Medicare's rule is that when more than one physician provides services in the global package, the amounts approved for all of them may not exceed what would have been paid had one physician provided everything. The surgeon bills the surgery code with modifier 54 (surgical care only), the physician who takes over recovery bills the same code with modifier 55 (post-operative management only), and a physician who provides pre-operative care only uses modifier 56. Both claims carry the date of surgery as the date of service and the same procedure code, and the date care was relinquished or assumed goes in the claim's remarks. The surgeon and the receiving physician must each keep a copy of the written transfer agreement in the patient's record, and the receiving physician cannot bill any part of the package until that physician has provided at least one service. Split-care billing does not apply to a 000 code. The booklet adds that modifier 54 is used whenever a practitioner plans to provide only part of a package, including an informal, undocumented but expected transfer, and that 54 and 55 do not apply to an assistant at surgery or to an ambulatory surgical center's facility fee.

Under section 40.4.B of the manual the contractor multiplies the fee schedule amount by the percentage and rounds to the nearest cent. The percentages cover the total relative value units for major surgeries and for minor surgeries with a 10-day period, and the intra-operative percentage includes post-operative hospital visits. A physician who bills with modifier 54 is assumed to have provided the pre-operative, intra-operative and in-hospital post-operative services, so that claim is paid the pre-operative and intra-operative portions combined. The post-discharge portion is what modifier 55 claims. The table applies those rules to the 11 codes that have a 10-day or 90-day window.

Source: PPRRVU2026_Oct_nonQPP (PRE OP, INTRA OP and POST OP columns) and GPCI2026, Detroit, Michigan Locality 01, CY2026, $33.4009 conversion factor; split rules from Medicare Claims Processing Manual chapter 12, section 40.4.B. Computed November 3, 2026. The amount used is the office amount for the office procedures and the facility amount for the other codes, so that each row has one starting point. Medicare anchors, not your bill.

The last column is the check a patient can run. In every row the two payments add back to the amount used, to the cent. If the surgeon's 54 line and the other physician's 55 line for the same date of surgery add to more than the global amount for that code in that locality, something other than a simple split has happened, and the manual makes exceptions only where stated policies pay more than the global amount, for example when a physician other than the surgeon provides both the pre-operative and the inpatient post-operative care. The manual notes one reason the sums can legitimately differ: when the two parts are furnished in different payment localities each is priced there, and the geographic adjustments mean the total will not equal the global amount in either.

The line most likely to confuse is the 55 claim itself. It names the same operation, on the date of the operation, from a physician the patient may have first met weeks later. On a statement that looks like a duplicate of the surgeon's charge. The difference is the modifier and the amount: a 55 line for the knee replacement should be close to $259.96 and a 54 line close to $977.96, not two near-full charges.

When the second physician takes over part-way through, the manual prorates the post-operative percentage by days. It divides the post-operative allowed amount by the number of post-operative days and multiplies by the days each physician was responsible. The manual's own example has a post-operative share of 17 percent and a 90-day period, with the first physician responsible for 60 days and the second for 30; the shares come to 11.3 percent and 5.7 percent of the total fee. Applying the same method to the knee replacement, with the surgeon responsible for 30 of the 90 days and the second physician for the other 60:

Source: PPRRVU2026_Oct_nonQPP and GPCI2026, Detroit, Michigan Locality 01, CY2026; method from Medicare Claims Processing Manual chapter 12, section 40.4.B. The 30 and 60 day split is an invented input chosen for the arithmetic. Per-day amounts shown to five decimals; each total is rounded to the cent. Computed November 3, 2026.

The result, $1,237.92, is the global amount again. The surgeon keeps 7 percent of the fee for the post-operative days worked and the second physician 14 percent. The manual's worked example computes only the two post-operative shares. Adding the surgeon's pre- and intra-operative portion to the surgeon's share follows from the paragraph above the example, which says a physician billing with modifier 54 is paid those two portions combined.

Not every post-operative visit by someone other than the surgeon needs 54 and 55. The manual says that when care does not transfer, occasional post-discharge services by a physician other than the surgeon are reported with the ordinary visit code and no modifier, as are follow-up services for minor procedures done in an emergency department (the physician who provides the follow-up bills the office visit code, and the emergency physician bills the procedure without a modifier). The booklet adds the add-on HCPCS code G0559 for post-operative care by a practitioner other than the surgeon or someone in the surgeon's group. In the October 2026 file G0559 carries a ZZZ global indicator and a fee schedule amount of $10.26 in an office and $8.65 in a facility. The CY2027 proposal also recounts that the CY2025 final rule expanded the transfer-of-care modifiers, with mandatory reporting where care passes between practitioners, and created a post-operative care add-on code for practitioners who were not involved in the surgery.

A return to the operating room, priced

A complication that is treated outside an operating room belongs to the surgeon's package. One that sends the patient back to the operating room does not: the procedure is billed with its own code and modifier 78, and the manual defines the operating room for this purpose as a place of service specifically equipped and staffed for the sole purpose of performing procedures, which includes a cardiac catheterization suite, a laser suite and an endoscopy suite and excludes a patient's room, a minor treatment room, a recovery room and, in most cases, an intensive care unit. Payment is reduced to the intra-operative share. The manual says the contractor pays the value of the intra-operative services of the code that describes the treatment, by multiplying the fee schedule amount by the intra-operative percentage. If no code describes the treatment and an unlisted code is used, the payment is at most 50 percent of the intra-operative value of the original surgery. A code with a 000 period billed with modifier 78 is paid in full, since such codes have no separate pre-, intra- or post-operative values.

Source: PPRRVU2026_Oct_nonQPP (INTRA OP column) and GPCI2026, Detroit, Michigan Locality 01, CY2026; method from Medicare Claims Processing Manual chapter 12, section 40.4.C (the unlisted-code cap is 0.50 x fee schedule amount x intra-operative percentage, applied to the original surgery). Computed November 3, 2026. A return procedure with its own code is priced from that code, so the "same code repeated" column is a scale, not a quote. Medicare anchors, not your bill.

The table gives the scale. A repeat of the hernia repair under modifier 78 is priced at $444.44, not the full $548.69 again, and an unlisted code for the treatment is capped at $222.22. The manual adds two rules for the same-session case: additional procedures done in the original operative session to treat complications of that operation are paid as multiple surgeries, and when the patient returns to the operating room later on the same day as the original surgery, the complications rules apply to each procedure and the multiple-surgery rules do not also apply. A bill that shows the original operation's code again with modifier 78 deserves a question about whether the identical procedure was repeated, because the manual says the original surgery's code is not used except when it was.

What an office visit is worth beside the package

The amounts below are the Medicare office and facility prices for the office visit codes for new and established patients, in the same locality. They put a figure on the line a clinic would be adding if a recovery visit were billed separately, and on a legitimate -24 or -57 line.

Source: PPRRVU2026_Oct_nonQPP and GPCI2026, Detroit, Michigan Locality 01, CY2026, $33.4009 conversion factor. The 20 percent column is Part B coinsurance on the approved amount, assuming the annual deductible is already met. Computed November 3, 2026. Medicare anchors, not your bill.

Code 99024 is the one that confuses patients. It stands for a post-operative follow-up visit that is normally included in the surgical package, and in the fee file it has status B, which the file's documentation defines as a bundled code whose payment is always bundled into payment for other services. Medicare uses it to count visits: practitioners in a group of ten or more in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon or Rhode Island who provide global services under the required procedure codes must report their post-operative visits with it. A $0.00 line with this code is a record that a visit took place, and it carries no coinsurance.

The coinsurance column makes the legitimate cases concrete. A recovery visit that is billed correctly as an unrelated problem with modifier 24 is an ordinary office visit: a 99213 approved at $95.55 leaves $19.11 of coinsurance after the deductible. The same visit billed without the modifier inside the window is, under the manual, to be denied.

What the statement and the notice show

When a visit that belongs to the package is billed anyway, the manual sets the messages that go to the physician and the patient. The remittance advice and the Medicare Summary Notice carry codes, and the manual gives them by situation.

Sources: Medicare Claims Processing Manual chapter 12, section 40.4.D (message numbers and group codes); X12 Claim Adjustment Reason Codes and Claim Adjustment Group Codes (code text; CO is "Contractual Obligation", PR is "Patient Responsibility"). Checked November 3, 2026.

The group code is the part that bears on what the patient is asked to pay. X12 defines CO as a contractual obligation and PR as patient responsibility, and the manual assigns CO, not PR, to each of these denials. The manual also says the limitation of liability provision (section 1879 of the Social Security Act) does not apply to these determinations, because they are fee schedule reductions, not denials based on medical necessity, and it caps what a nonparticipating physician may bill on an unassigned claim for services in the package at the limiting charge for the surgical procedure. The limiting charge guide works that ceiling in dollars. A patient who received a statement for a denied recovery visit should compare it with the notice and the explanation of benefits (see the guide to reading an explanation of benefits) and with the itemized bill checklist, which covers the duplicate and unbundled lines this situation produces. The wording of each notice message is not reproduced here; only the message numbers the manual assigns are given.

Nothing in this section is a statement about what a commercial plan does. Plans publish their own payment policies, and some adopt Medicare's global periods while others apply their own rules. The plan's policy decides which visits it pays, and the only way to know is to ask it in writing, with the surgery's CPT code and date.

Six visits after one hernia repair and one drainage

The table below puts the rule to work on invented visits after two operations: a hernia repair (49505) on March 3, 2026, and an office drainage of an abscess (10060, office amount $128.61) on October 6, 2026. The visit codes and amounts come from the visit table above, and the dates come from the calendar counts earlier.

Sources: Medicare Claims Processing Manual chapter 12, sections 40.1, 40.2.A, 40.3.B and 40.4.A; PPRRVU2026_Oct_nonQPP and GPCI2026, Detroit, Michigan Locality 01, CY2026. The visits, dates and diagnoses are invented to illustrate the rule. Computed November 3, 2026. Medicare anchors, not your bill.

Two comparisons follow from the table. The wound-check charge of $95.55 is larger than the whole post-operative share of the hernia repair, $54.87, so a clinic that billed it would collect more for one visit than the fee assigns to all recovery care in the office, although one figure is an office amount and the other a share of a facility amount. And the same visit on June 2, 2026 is an ordinary service, because day 91 is the first day the package no longer covers. The day count is what a patient should recompute on any follow-up line, starting from the date of surgery on the statement, since the difference between a payable visit and a denied one is often a single date.

A 000-day operation gives the simplest case. A diagnostic colonoscopy (45378) carries no post-operative days, so a visit two weeks later to go over a result is outside the package and billed as an ordinary visit. A visit on the day of the procedure itself is another matter: it is included unless it was a significant, separately identifiable service, in which case modifier 25 applies, the same logic the cortisone shot guide applies to the 000-day injection code.

What the CY2027 proposal would change

As of November 3, 2026 the CY2027 physician fee schedule rule is a proposal. CMS published it in the Federal Register on July 16, 2026 (91 FR 43842) with comments due September 14, 2026, and a search of the Federal Register and its public-inspection list on November 3 returned no final rule. The rules described above are the current ones.

Three parts of the proposal touch global surgery. First, CMS proposes to reduce payment when a separately identifiable office or outpatient visit is billed on the same day as a procedure with a 0-, 10- or 90-day global period: the most expensive service would be paid at 100 percent and the other services at 50 percent. That targets the modifier 25 situation on the day of a procedure, not a -24 visit during the window. Second, CMS proposes to pause the post-operative data collection required by the Medicare Access and CHIP Reauthorization Act (MACRA), the 99024 reporting, while asking whether all providers should report that code. Third, CMS posts a public use file of imputed work values for the 10-day and 90-day post-operative visits, based on the visits reported with 99024, and invites comment on revaluation strategies. In a separate passage about another public use file, CMS seeks comment on how it could "right-size" payments for the globals over time and states: "We emphasize that we are not proposing any changes to existing payment or billing policies, including the use of the 010- and 090-day globals. Rather, this effort is intended to improve transparency and provide a foundation for future rulemaking." The proposal recounts the history behind that caution: the CY2015 final rule finalized a policy to transition 10-day and 90-day globals to 0-day globals, and section 523(a) of MACRA prohibited CMS from implementing it.

Until a final rule is issued, the window counts and modifier rules above are the ones in force. Before a planned operation, the cheapest time to ask the surgeon's office how it handles post-operative visits, and whether it expects to bill any, is the same conversation as the list in the guide to billing questions to ask before a procedure.

Global period billing questions

Primary sources for every rate and rule

• CMS, MLN Booklet: Global Surgery, MLN907166 (December 2025; "No substantive content updates"): the three global packages and their day counts, what is and is not included, modifiers 24, 25, 54, 55, 56, 57, 58, 78 and 79, G0559, code 99024 reporting and the nine states, critical care and FT. Checked November 3, 2026.
• CMS, Medicare Claims Processing Manual, chapter 12 (Rev. 13753, issued 05-07-26): sections 40.1 (package and the day count), 40.2 (billing requirements and modifiers), 40.3 (claims review and prepayment edits), 40.4 (adjudication, split global care, return trips to the operating room, remittance and notice messages) and 40.5 (postpayment). The CMS manuals page lists the chapter. Checked November 3, 2026.
• CMS, Physician Fee Schedule relative value file RVU26D (October 2026 release; PPRRVU2026_Oct_nonQPP released 08/26/2026; GPCI2026; RVU26D documentation): global indicators, pre-, intra- and post-operative percentages, work, practice expense and malpractice RVUs, the $33.4009 conversion factor, status codes, and the indicator definitions. Computed November 3, 2026.
• Federal Register, Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule (proposed rule, 91 FR 43842, July 16, 2026; document 2026-14327): the global surgery discussion, the modifier 25 proposal and the 99024 data collection. Searched on November 3, 2026 for a final rule, in published documents and the public-inspection list, with no result.
• X12, Claim Adjustment Reason Codes (97, B15 and B20) and Claim Adjustment Group Codes (CO and PR). Checked November 3, 2026.

General billing information, not medical, legal or insurance advice. The rules here are Medicare's. A commercial plan's policy and contract decide what it pays, the message text on a Medicare Summary Notice is not reproduced, and Medicare anchors are not your bill. Confirm your price in writing before service.