Global indicator 090: one day before, ninety after.

What 090 means

CMS defines 090 as major surgery with a 1-day preoperative period and 90-day postoperative period included in the fee schedule payment amount (Chapter 23, section 50.6). The total is 92 days: one day before surgery, the surgery day and the 90 days after it (MLN booklet). CMS's example is surgery on January 5, preoperative period January 4 and last postoperative day April 5.

Inside the package

• Preoperative visits after the decision to operate, starting the day before surgery.
• Intra-operative services that are a usual and necessary part of the procedure.
• Complications that do not require a return trip to the operating room.
• Related follow-up visits during recovery and post-surgical pain management by the surgeon.
• Supplies, and miscellaneous services such as dressing changes, local incision care and removal of sutures, staples, drains and casts.

Billed separately

• The visit that first decides on surgery on the day before or day of the operation (modifier 57).
• Visits unrelated to the surgical diagnosis and treatment of an underlying condition not part of normal recovery.
• Diagnostic tests, and distinct procedures that are not re-operations or complication treatment; a new postoperative period begins.
• Treatment of a complication that requires a return to an operating room. CMS defines that as a place equipped and staffed for procedures, including a cardiac catheterization, laser or endoscopy suite, but not a patient room, minor treatment room, recovery room or ICU unless the patient was too critical to be moved.
• A less extensive procedure that fails and needs a more extensive one, organ transplant immunosuppressive therapy, and critical care unrelated to the surgery.

Dividing the package

The payment file carries preoperative, intraoperative and postoperative percentages for modifiers 56, 54 and 55; they usually total one, give or take rounding (Chapter 23, section 50.6). When surgeon and another physician agree on transfer of care, the total they are paid cannot exceed what one physician would have received, except where stated policy allows more.

Worked example

Surgery on January 5, 2026: preoperative day January 4, last postoperative day April 5. A related visit on March 20 is inside the package. A visit on April 6 is outside it. The calculator above runs the same arithmetic for any date, including leap years.

Compare

See 010, 000, or the all-in-one calculator.

FAQ

How many days are in a 090 global period?

Ninety-two: one preoperative day, the day of surgery and 90 postoperative days.

Is the surgeon's first visit on the day before surgery included?

No, if it results in the first decision to operate. That visit is billed with modifier 57. Later preoperative visits are included.

Is a return to the operating room for a complication included?

No. Treatment of a complication that requires a return trip to an operating room is payable separately.

Do other physicians fall under the surgeon's global package?

Not by default. Services by other physicians are separate unless the surgeon and the other physician agree on a transfer of care.

What if the patient has an unrelated problem during the 90 days?

Visits unrelated to the diagnosis for which the surgery was performed, unless caused by complications, are not part of the package.

Sources

Retrieved 2026-11-02 from the CMS documents below. Indicator meanings are paraphrased from the CMS definitions; no AMA CPT descriptors are reproduced. CMS revises the fee schedule and its manuals, so check the current text.

• CMS: Medicare Claims Processing Manual, Chapter 23, Fee Schedule Administration and Coding Requirements (Rev. 13701, issued 06-16-26): section 50.6, Global Surgery value 090 and the percentage fields (retrieved 2026-11-02).
• CMS: Medicare Claims Processing Manual, Chapter 12, Physicians/Nonphysician Practitioners (Rev. 13753, issued 05-07-26): sections 40.1.A, 40.1.B and 40.1.E (retrieved 2026-11-02).
• CMS: MLN907166, Global Surgery booklet (December 2025): FAQs and Pre-Operative Period Billing (retrieved 2026-11-02).