Medicaid programs and commercial payers may adopt the Current Procedural Terminology (CPT®) or the Centers for Medicare & Medicaid Services (CMS) global surgery guidelines, or establish their own policies. Reporting surgical procedures and understanding the CPT and CMS surgical guidelines has been addressed in several AAP Pediatric Coding Newsletter™ issues. However, its importance cannot be overstated and it is worth summarizing again. For more detail, please visit http://coding.aap.org, click on “Newsletter Archive,” and access the following articles:
The following guidelines are applicable to CPT codes 10021–69990:
Commercial payers establish their own surgical package definitions and guidelines. Most follow the CPT surgical package definition but follow the CMS global periods. Know your major payer’s specific billing requirements.