Medicare has long valued and paid for surgical procedures using global surgical packages that reflect the time and work involved in the procedures themselves, as well as pre- and post-operative care over specified time frames known as global periods. The Centers for Medicare & Medicaid Services (CMS) collects data on the post-operative care furnished during global periods and has, over several years, sought public comment on approaches to use these data and other inputs to improve global surgical package valuation.
This report presents findings from four analyses of claims data related to global surgical services conducted from September 2023 to September 2025: (1) the extent to which post-operative visits included in the global surgical package are actually provided to patients, as determined by observed-to-expected (O/E) ratios; (2) the types of services provided during global periods by practitioners other than the operating surgeon; (3) within-practice specialization in the provision of post-operative care during evaluation and management (E&M) visits; and (4) alternative methods to split the valuation for global surgical services.
CMS has repeatedly committed to improving the accuracy of global service valuations, most recently in its 2026 Physician Fee Schedule (PFS) Final Rule. Given the magnitude and persistence of disconnects between real-world patterns of patient care and assumptions underlying the valuation of surgical procedures under the PFS, CMS will likely need to broadly revalue all global surgical services. The analyses presented in this report provide examples of how this broad revaluation can be data-driven, transparent, and revisited over time.
This work was sponsored by the Centers for Medicare & Medicaid Services and conducted in the Financing and Organization Program of RAND Health.
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