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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that providers/suppliers must report services correctly. Procedures should be reported with the 
Current Procedural Terminology (CPT) code that describes the services performed. You can find this rule in 
the Centers for Medicare and Medicaid Services, Medicare National Correct Coding Initiative Policy Manual 
for Medicare Services, Chapter I(A). 
 
Medicare guidance says Field Name & Description: Global Surgery &This field provides the 
postoperative time frames that apply to payment for each surgical procedure or another indicator that 
describes the applicability of the global concept to the service. ZZZ = Code related to another service 
and is always included in the global period of the other service. You can find the guidance in the 
Medicare Claims Processing Manual Chapter 23 - Fee Schedule Administration and Coding 
Requirements, SEC-50.6. 
 
Medicare guidance says An add-on code is a HCPCS/CPT code that describes a service that, with one 
exception (see CR7501 for details), is always performed in conjunction with another primary service 
An add-on code with one exception is eligible for payment only if it is reported with an appropriate 
primary procedure performed by the same practitioner. An add-on code with one exception is never 
eligible for payment if it is the only procedure reported by a practitioner. Add-on codes may be identified 
in three ways: 
 
1.The code is listed in this CR or subsequent ones as a Type I, Type II, or Type III add-on code. 2. On the 
Medicare Physician Fee Schedule Database an add-on code generally has a global surgery period of 
"ZZZ".3.In the CPT Manual an add-on code is designated by the symbol "+". The code descriptor of an 
add-on code generally includes phrases such as "each additional" or "(List separately in addition to 
primary procedure)." 
CMS has divided the add-on codes into three groups to distinguish the payment policy for each group.1). 
Type I - A Type I add-on code has a limited number of identifiable primary procedure codes. The CR 
lists the Type I add-on codes with their acceptable primary procedure codes. A Type I add-on code, with one exception, is eligible for payment if one of the listed primary procedure codes is also eligible for 
payment to the same practitioner for the same patient on the same date of service. Claims processing 
contractors must adopt edits to assure that Type I add-on codes are never paid unless a listed primary 
procedure code is also paid. You can find the guidance in the CMS.GOV Add-on Code Edits. 
Medicare guidance says For Add-on code 36907 appropriate Primary Codes 
36818, 36819, 36820, 36821, 36823, 36825, 36830, 36831, 36832, 36833, 36901, 36902, 36903, 36904, 36905, 
36906. You can find the guidance in the Final Complete File of Add-on Code Edits for October 01, 2021 
Implementation for Medicare, Type I CPT Manual, HCPCS Manual, and/or CMS Policy defines all 
acceptable primary codes. 
 
Medicare guidance says CPT code 36907, Global days "ZZZ". you can find the guidance in the October 
2021 National Physician Fee Schedule Relative Value File. 
 
Medicare guidance says the A/B MACs (A) must provide a listing of the required data elements, 
including a brief explanation to providers and suppliers. A/B MACs (A) must educate providers 
regarding the distinction between submissions which are not considered claims, but which are returned to 
provider (RTP) and submissions which are accepted by Medicare as claims for processing but are not 
paid. Claims may be accepted as filed by Medicare systems but may be rejected or denied. Unlike RTPs, 
rejections and denials are reflected on RAs. Denials are subject to appeal, since a denial is a payment 
determination. Rejections may be corrected and resubmitted. You can find the guidance says Medicare 
Claims Processing Manual Chapter 1 - General Billing Requirements Section 70.2.3.2 and 80.3.1. 
 
Medicare says that there are specific rules for the time spans before and after surgery that are considered part of 
the surgical procedure. This time span is called a Global Surgical Package. The Medicare Fee Schedule Data 
Base (MFSDB) provides the postoperative periods that apply to each surgical procedure. They can be 0 days, 
10 days or 90 days. If there is an indicator of 000, postoperative visits beyond the day of the procedure are not 
included in the payment amount for the surgery.  You can find this rule at Medicare Claims Processing Manual 
Chapter 12 Section 40.1. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.