CMS Pub. 100-02, ch. 13, § 40.4

Surgical procedures furnished in an RHC or FQHC by an RHC or FQHC practitioner are

considered RHC or FQHC services. Procedures are included in the payment of an

otherwise qualified visit and are not separately billable. If a procedure is associated with

a qualified visit, the charges for the procedure go on the claim with the visit. Payment is

included in the AIR when the procedure is furnished in an RHC, and payment is included

in the PPS methodology when furnished in an FQHC. The Medicare global billing

requirements do not apply to RHCs and FQHCs, and global billing codes are not

accepted for RHC or FQHC billing or payment.

Surgical procedures furnished at locations other than RHCs or FQHCs may be subject to

Medicare global billing requirements. If an RHC or FQHC furnishes services to a patient

who has had surgery elsewhere and is still in the global billing period, the RHC or FQHC

must determine if these services have been included in the surgical global billing. RHCs

and FQHCs may bill for a visit during the global surgical period if the visit is for a

service not included in the global billing package. If the service furnished by the RHC or

FQHC was included in the global payment for the surgery, the RHC or FQHC may not

also bill for the same service.

Services not included in the global surgical package are listed in Pub. 100-04, Medicare

Claims Processing Manual, chapter 12, section 40.1.B, and include, but are not limited to:

initial consultation by the surgeon to determine the need for major surgery; visits

unrelated to the diagnosis for which the surgical procedure is performed (unless the visit

occurs due to complications of the surgery); treatment for the underlying condition or an

added course of treatment which is not part of normal recovery from surgery; etc.

For additional information on global billing, see http://www.cms.gov/Regulations-and-

Guidance/Guidance/Manuals/downloads/clm104c12.pdf