Data Collection on Resources Used in Furnishing Global Services
Medicare payment for most surgical procedures covers both the procedure and post-operative visits occurring within a global period of either 010 or 090 days following the procedure. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) mandated that CMS collect data on the number and level of post-operative visits to enable CMS to assess the accuracy of global surgical package valuation. To help inform accurate valuation of procedures with global periods (for cataract surgery, hip arthroplasty, and complex wound repair), Medicare required select practitioners from nine states (Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island) to report on their post-operative visits (using CPT code 99024) following high volume or high cost procedures beginning July 1, 2017. The expected number of post-operative visits after a procedure was determined using the time file, which captures the number of visits used in the initial valuation.
List of CMS codes with global period of either 010 or 090 days by year.
CMS list of Global Codes for which reporting on post-operative visits is required CY 2021 to CY 2017. (For more details on the reporting requirements, see 81 FR 80209.)
RAND Reports of codes with global period of either 010 or 090 days
This RAND report describes how the reverse building block approach would revalue procedures with 010- and 090-day global periods using this newly-collected data on the number of post-operative visits performed. This information is for consideration only. Revaluing procedures with 010- and 090-day global periods resulted in substantial reductions in total RVUs across all Physician Fee Schedule services for proceduralist specialties and slight increases in RVUs for some other specialties.
RAND Report: “Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data” (2021).
RAND Report: “Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods” (2019).
RAND Report: “Survey-Based Reporting of Post-Operative Visits for Select Procedures with 10- or 90-Day Global Periods Final Report” (2019).
RAND Report: “Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day; Global Periods - Updated Results Using Calendar Year 2019 Data” (2021).
RAND Report: “Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods - Final Report” (2019: July 1, 2017 and June 30, 2018 data from nine states)
RAND Report: “NEW CLAIMS-BASED REPORTING REQUIREMENTS FOR POST-OPERATIVE VISITS. GUIDE FOR PRACTITIONERS JUNE 2017”
CMS Global-Surgery-FAQs (PDF) (June 2017)
In the CY 2017 proposed rule, CMS proposed to use a set of no-pay G-codes to capture post-operative care on claims. For more on this proposal see pages 46191 - 46200 of the CY 2017 proposed rule (CMS-1654-P). In making our proposal, we relied heavily upon codes developed for reporting post-operative care by RAND under a contract with CMS. Also, as part of this contract RAND was required to test the G-codes that CMS proposed to assess whether practitioners understood the codes and could accurately apply them. RAND Report: “Testing New Codes to Capture Post-Operative Care” (2017) details the results of this testing.
RAND Report: “Developing Codes to Capture Post-Operative Care” (2016)
RAND Report: “Testing New Codes to Capture Post-Operative Care” (2017)
CMS references to Final Rules concerning 010 and 090 Global days codes involved with post-op data collection.
CMS is required to collect data to use in valuing global surgical services by Section 1848(c)(8)(B) of the Social Security Act. For more information on the data collection effort, we refer readers to pages 80209 - 80225 of the CY 2017 PFS final (CMS-1654-F).
In addition to this claims-based data collection, CMS has contracted with RAND to conduct a survey to collect additional data on pre- and post-operative services. For more information on the survey, we refer readers to pages 80222 - 80224 of the CY 2017 PFS final rule (CMS-1654-F).
For Further Information Contact MACRA_Global_Surgery@cms.hhs.gov