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M144 Remark Code: Pre/Post-Op Care in Surgical Payment

M144 means the payer considers the pre-operative or post-operative care you billed to be included in its payment for the surgery or procedure. The care falls inside the global surgical package, so it is not paid as a separate service.

Quick facts

Code
M144 (RARC M144)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The care is bundled into the surgical payment. The provider writes off the line and cannot bill the patient for it.
Official description
Pre-/post-operative care payment is included in the allowance for the surgery/procedure.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What M144 means

Most surgical procedures carry a global period. The payment for the surgery covers not only the operation but also routine care immediately before and after it. When a claim includes a visit or service that the payer places inside that package, it denies the line and uses M144 to explain why: the pre-operative or post-operative care is already part of the surgical allowance.

It typically appears with CARC 97 or 234. This is a bundling outcome, not a documentation denial, so resending the same line will produce the same result.

Common causes

  • A routine follow-up visit was billed during the post-operative period.
  • A pre-operative evaluation the day before or of surgery was billed without a modifier showing it was the decision for surgery.
  • A visit for an unrelated problem was billed without modifier 24 or 25.
  • A second provider billed post-operative care without the split-care modifiers the payer expects.
  • The surgery’s date or global period was recorded differently by the payer than by your office.

How to fix it

  1. Confirm the global period. Look up the procedure’s global days and check whether the visit date falls inside it.
  2. Review the documentation. Decide whether the visit was truly routine care or was unrelated, a significant separate service, or the decision for surgery.
  3. Correct and resubmit when supported. Add the appropriate modifier in box 24D and send a replacement claim with resubmission code 7 in box 22.
  4. Appeal with records. If a modifier was already present, send the note showing the separate problem or the decision for surgery.
  5. Write off true global care. Routine pre- and post-operative care within the package is not billable to the patient.

How to prevent it

Flag patients in an active global period in your scheduling system and require a coder review before any visit in that window is billed. A Claims Validator can catch visits falling inside a global period before submission. For broader bundling rules, see NCCI bundling and modifiers.

Codes that may appear with M144

  • CO-97 (The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.): The benefit for this service is included in the payment for another service, here the surgery.
  • CO-234 (This procedure is not paid separately.): The procedure is not paid separately, with M144 explaining that the surgical allowance covers it.
  • M15 (Separately billed services/tests have been bundled as they are considered components of the same procedure.): Separately billed services were bundled as components of the same procedure, not specific to pre- and post-operative care.
  • N20 (Service not payable with other service rendered on the same date.): A service is not payable with another service on the same date, a same-day bundling edit rather than a global period.
  • N390 (This service/report cannot be billed separately.): The service or report cannot be billed separately.
  • CO-B20 (Procedure/service was partially or fully furnished by another provider.): Used when the service was partly or fully furnished by another provider.

M144 FAQ

What is included in a global surgical package?

Under Medicare, it generally includes routine pre-operative visits within a set window, the procedure, and routine post-operative follow-up and complication care that does not require a return to the operating room. Commercial payers often follow similar rules but can differ.

Can I ever bill a visit during the global period?

Yes, when it is unrelated to the surgery or is the visit where the decision for major surgery was made. Modifiers such as 24, 25, 57, or 79 communicate these situations, but only when the documentation supports them.

Does M144 apply to a different surgeon's care?

It can, if the payer believes the surgeon was paid for all the care. When care is split between providers, modifiers 54, 55, and 56 tell the payer who furnished which part.