How to Navigate the Transfer of Care During the Global Period in 2025

Medicare defines the global period by the preoperative, intraoperative, and postoperative phases of surgical care and refers to a specified timeframe (0, 10, or 90 days) during which all services related to a surgical procedure are included in the procedure. For major procedures with a 90-day global, a surgeon ( and his/her partners of the same specialty) are reimbursed a “global fee’ to provide pre-operative, intraoperative as well as post-operative care for 90 days after the surgery.

As we move into 2025, understanding how to properly report the transfer of patient care during the global surgical period remains critical.

Key Global Package Modifiers for Transferring Care: These modifiers and their intended use are not new. However, Medicare loosened its guidelines when appending Modifier 54 to assess reimbursement inequities.

Modifier 54 (Surgical Care Only): Append Modifier 54 to the surgical CPT code when you perform the surgical procedure but do not intend to manage the patient’s postoperative care.

2025 Update: Modifier 54 may be appended even without formal, documented transfer of care—anticipation of transfer (informal or non-documented) now suffices.

Modifier 55 (Postoperative Management Only): Append Modifier 55 when you assume the patient’s postoperative management following surgery.

There has been no change in the requirements when providing postoperative management only. A formal agreement and documented transfer of care is required from both the transferring and receiving providers. Include the date of transfer and specify the scope of services provided. Store this document in the patient’s medical record.

Modifier 56 (Preoperative Management Only): Rarely used or recognized by payors, Modifier 56 is appended if you provide only preoperative care before the surgery.

No Formal Transfer of Care? Consider Evaluation and Management (E/M) Coding. If the provider rendering postoperative management lacks a formal, documented transfer of care, bill the appropriate E/M code instead of using Modifier 55.

Add-On Code G0559:

• G0559 is an add-on code created by CMS for postoperative follow-up visit complexity inherent to E/M services.

• It may be reported when:

  • Postoperative care is provided by a practitioner, not in the same group as the surgeon.

  • The practitioner providing postoperative care can be of the same or different specialty.

  • It is billed once within the 90-day global period when there has been no formal transfer of care from the operating practitioner.

• The provider should bill the appropriate level of E/M service and G0559 to the first E/M visit during the patient’s post operative period of the surgery performed elsewhere.

KZA’s Bottom Line: For 2025, Medicare has modified the requirement to bill Modifier 54.  Modifier 54 can now be appended with or without a formal written transfer of care.  If you are the practitioner rendering postoperative care only, and no formal transfer of care exists, we recommend coding the appropriate E/M service and G0559 for the first postoperative visit. If a formal transfer exists, continue your current practice.

Sources:

https://www.cms.gov/files/document/mln907166-global-surgery-booklet.pdf

Medicare Physician Fee Schedule Final Rule Summary CY 2025 (MM13887)