Clarification of Global Surgery Tab in the Fee Schedule

March 27, 2013

The Fee Schedule file lists the components of a global surgical package, billing and payment rules for surgeries, endoscopies, and global surgical packages that are split between two or more physicians. The Global Surgery Tab lists the Medicare covered codes because MaineCare follows Medicare billing guidelines, but inclusion on this tab does not reflect coverage by MaineCare.

The fee schedule on the Health PAS Online Portal includes the following:

  • Usual, Customary, and Reasonable (UCR) rates

  • Rates for physician services, physician assistants, nurse practitioners, and other practitioners under MaineCare Benefits Manual, Chapter II Section 90

  • Rates for Durable Medical Equipment (DME)

Other tabs include rates for MaineCare covered codes for Injectable Drugs, Radiology, and Podiatry/Optometry, as well as Global Surgery Rules. It does not include procedure codes for all provider types.

Medicare has established a national definition of a global surgical package to ensure that payment is made consistently for the same services across all Medicare contractor jurisdictions. This policy helps prevent payments for services that should be included in the global rates. In addition to the global policy, uniform payment policies and claims processing requirements have been established for other surgical procedures, including bilateral and multiple surgeries, co-surgeons, and team surgeries. Fee schedules are subject to change. A list of non-covered codes is included on the last tab of this file. However, it is adjusted regularly. Finding a code on one of the fee schedule tabs, including the Global Surgery Rules tab, does not guarantee that the code is covered. You should refer to the applicable section of Chapter III in the MaineCare Benefits Manual, Allowances for Services.