Global periods, explained for the people who run the schedule
Every orthopedic surgery starts a clock. Schedule the wrong visit type while that clock is running and the claim comes back denied. Here's how the clock works.
The three clocks
Medicare's Physician Fee Schedule assigns every surgical procedure one of three global periods, and commercial payers largely mirror the structure:
| Global period | What it means | Typical orthopedic examples |
|---|---|---|
| 0 days | Only the procedure itself is bundled. Follow-up visits are billable normally. | Joint and trigger-point injections, most epidural steroid injections, many needle procedures |
| 10 days | Procedure plus routine care for 10 days after. | Many minor skin and soft-tissue procedures, some closed fracture care without manipulation |
| 90 days | Procedure, the day before, and routine related care for 90 days after. | Joint replacement, spinal fusion, rotator cuff repair, ORIF fracture surgery, carpal tunnel release, most therapeutic arthroscopy |
Global periods are assigned per CPT code in the CMS Physician Fee Schedule. Always confirm a specific code's global indicator in the current CMS PFS lookup tool — assignments can change year to year.
What's inside the bundle — and what isn't
Included in the global package
- Routine post-operative visits related to the procedure (the “how's the incision, how's the motion” visits)
- Typical post-op pain management by the surgeon
- Suture and staple removal, cast changes by the operating surgeon's team
- Most complications managed without a return to the operating room
Billable separately, usually with a modifier
- Unrelated problems during the window (modifier 24 on the visit) — the knee patient's new shoulder pain
- Return trips to the OR for related complications (modifier 78) or staged/planned procedures (modifier 58)
- Unrelated procedures during the window (modifier 79) — including the second side of a staged bilateral joint replacement
- The decision-for-surgery visit the day of or day before a major procedure (modifier 57)
Our modifier guide covers each of these with examples.
The scheduling mistakes that turn into denials
- Booking a global follow-up as a new evaluation. The most common one. The patient calls 3 weeks after their knee replacement, the scheduler doesn't check surgical history, and the visit goes in as a billable E/M. The claim denies, or worse, pays and gets clawed back.
- Missing the second side of a staged bilateral. The left knee is inside the right knee's global period. The surgery is billable (modifier 79), but the scheduling and coding have to agree it's a distinct procedure.
- Injection series that drift. A viscosupplementation series has its own cadence rules; letting a patient book “whenever” creates medical-necessity gaps.
- Losing the 90-day boundary. Day 89 and day 91 are different billing worlds. Schedulers who can't see the surgery date can't know which side of the line a visit lands on.
How ClinicFlow handles this on live calls
ClinicFlow's scheduling agent checks surgical history before choosing a visit type, so a post-op caller books a global follow-up and a new-problem caller books an evaluation — at 2 p.m. or 2 a.m. It's the same rule set documented on this page, enforced on every call. Hear it on the live demo line: (281) 502-8583.
Related reading: Injection series and global periods on the schedule · Modifier guide · Prior auth guide
Educational summary, not billing or coding advice. Global period assignments live in the CMS Physician Fee Schedule and payer policies vary.
Frequently asked questions
What is a global period?
A global period is the window after a procedure during which routine follow-up care related to that procedure is bundled into the payment for the surgery itself. Medicare assigns each procedure a global period of 0, 10, or 90 days, and most commercial payers follow the same structure. Visits inside the window that are part of normal recovery are not billed separately.
What global period do most orthopedic surgeries have?
Major orthopedic procedures — joint replacements, spinal fusions, fracture repairs, most arthroscopic surgeries with intervention — generally carry a 90-day global period. Minor procedures like joint injections typically carry a 0-day global period, and a small middle group carries 10 days.
Can a patient be seen for a different problem during a global period?
Yes. The global period only bundles care related to the operated problem. A knee-replacement patient who develops shoulder pain can be seen and billed for the shoulder visit, typically with modifier 24 on the E/M service to show it was unrelated to the surgery.
Why do global periods matter for scheduling?
Because the visit type must match the billing reality. If a post-op patient is booked as a new evaluation instead of a global follow-up, the claim gets denied or the patient gets billed incorrectly. Schedulers — human or AI — need to know the patient is inside a global window before choosing the visit type.
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