Orthopedic Billing Services // CY2026

Route every post-op touchpoint to the right global-period modifier

The global surgical package bundles routine follow-up into the surgery fee. The revenue you are owed lives in the visits that are not routine. Here is the flow that keeps them from disappearing.

Answer first

During a 10 or 90 day global period, a post-op encounter is either bundled or billable. If it is billable, exactly one of six modifiers unlocks it: 24, 25, 57, 58, 78, or 79. Pick by three questions, related or unrelated, planned or unplanned, back to the OR or not. Get those right and the bundled visits stop leaking.

Foundation // Medicare Claims Processing Manual Ch. 12 §40

Three global periods set the whole clock

The MPFS indicator on every CPT code tells you the follow-up window that is already paid inside the surgical fee. Modifier choice depends entirely on which window you are inside.

000Zero-day

Minor procedures and endoscopies

No post-op days bundled. A separately identifiable same-day E/M is reported with modifier 25.

010Ten-day

Minor surgery, eg simple fracture care

Day of service plus 10 follow-up days bundled. Minor status means modifier 57 does not apply, use 25 for a same-day E/M.

090Ninety-day

Major surgery, eg joint replacement, ORIF

One pre-op day plus day of service plus 90 follow-up days bundled. This is where 24, 57, 58, 78 and 79 do their work.

The routing engine // three questions, six exits

The post-op modifier flow

Walk each encounter left to right. The gates on the left resolve to exactly one modifier node on the right. No guessing, no default to bundled.

Is it an E/M visit, or a procedure?

E/M→ go to gate 2

PROC→ go to gate 3

Is the E/M related to the surgery?

UNRELATED, in global→ Mod 24

SAME-DAY, separate→ Mod 25

DECIDES MAJOR SURGERY→ Mod 57

ROUTINE FOLLOW-UP→ bundled · 99024

Was it planned, and did it use the OR?

PLANNED or staged, related→ Mod 58

UNPLANNED return to OR, related→ Mod 78

UNRELATED procedure→ Mod 79

Unrelated E/M in the post-op period

Same physician · separate problem

The visit has nothing to do with the surgery but falls inside the global window.

Ortho: a 90-day TKA patient returns for unrelated shoulder pain. E/M with 24.

Global window unchanged

Significant, separate same-day E/M

Same day as a 0 or 10 day procedure

A distinct, documented E/M above the usual pre-service work of the minor procedure.

Ortho: new-injury evaluation plus same-day joint injection. E/M with 25.

Unbundles the same-day E/M

Decision for major surgery

Day of or day before a 90-day procedure

The E/M at which the initial decision to operate is made. Major surgery only.

Ortho: ED consult that decides hip-fracture ORIF for the next morning. E/M with 57.

Unbundles the decision E/M

Staged or related, planned

Same physician · anticipated at first surgery

A more extensive or planned next stage, or therapy following a diagnostic procedure.

Ortho: planned hardware removal or a staged second-stage procedure within the 90 days.

Starts a new global period

Unplanned return to the OR, related

Complication of the original surgery

Back to the operating or procedure room for a related problem that was not planned.

Ortho: post-op washout for deep infection, or hematoma evacuation after fixation.

No new global · intra-op value only

Unrelated procedure in the post-op period

Same physician · different problem

A separate procedure unrelated to the first surgery, performed inside its global window.

Ortho: contralateral knee arthroscopy while the first knee is still in its 90 days.

Starts a new global period

Quick reference // AMA CPT 2026 · NCCI Policy Manual 2026

The six modifiers at a glance

Mod	Use when	Global period effect	Payment note
24	Unrelated E/M during another procedure's post-op period	Existing window unchanged	E/M paid separately; diagnosis must support the unrelated reason
25	Separately identifiable same-day E/M with a 0 or 10 day procedure	No global impact	E/M paid in addition to the minor procedure
57	E/M that decides a major (90-day) surgery, day of or day before	Removes E/M from the bundle	Major surgery only; 25 is the minor-surgery counterpart
58	Planned, staged, or more extensive related procedure by the same physician	New global period begins	Full value; anticipation should be evident in the record
78	Unplanned return to the OR for a related complication	No new global period	Paid at the intra-operative percentage only
79	Unrelated procedure by the same physician during the post-op period	New global period begins	Full value; a distinct diagnosis is what separates 79 from 78

Where the money actually leaks

Four failure points that quietly bundle billable work

01Defaulting to 99024

Reporting the no-charge post-op visit code 99024 on an encounter that was actually unrelated. The 24 was the missed charge, not a courtesy visit.

02Swapping 78 for 79

Calling a related complication return an unrelated procedure. 79 restarts the global clock, 78 does not. The wrong pick triggers takebacks on audit.

0325 where 57 belongs

Using 25 on the decision E/M for a 90-day surgery. On major procedures the correct unlock is 57; 25 can be denied as inappropriate for the global tier.

04Thin documentation

Modifiers 24, 25 and 79 all lean on a distinct diagnosis and note. Without it the payer reads related, bundles the line, and the appeal has no ground to stand on.

Cited 2026 guidance

Built on the current rules, by name

CMS-1832-FCY2026 Medicare Physician Fee Schedule Final RuleSets the global surgical package structure and the CY2026 conversion factor updates that price every bundled and unbundled line.

Pub 100-04Medicare Claims Processing Manual, Chapter 12, Section 40Defines the global surgery package, the 000, 010 and 090 day indicators, and what is and is not included in the surgical fee.

NCCI 2026National Correct Coding Initiative Policy Manual, 2026Governs modifier appropriateness, related versus unrelated logic, and the edits that drive post-op denials.

AMACPT 2026 modifiers 24, 25, 57, 58, 78, 79The official descriptors for each global-period modifier used throughout the routing flow above.

CMS 99024Global Surgery Data CollectionThe ongoing post-operative visit reporting requirement via CPT 99024, and the reason routine follow-ups still need a code.

54 / 55Transfer-of-care modifiersSurgical care only and post-operative management only, for split global billing when a second practitioner manages recovery.

Turn modifier discipline into recovered revenue

ASP-RCM Solutions builds this routing logic into orthopedic billing workflows, so each post-op encounter lands on the right modifier before the claim goes out, not after a denial. Fewer takebacks, cleaner appeals, and the bundled visits that were quietly leaking, captured.

Talk to our ortho RCM team →

This page summarizes published CY2026 guidance for operational use and is not a substitute for payer-specific coverage policy or coding advice. Always confirm against your carrier's current rules.