- Admission and Discharge Services
- Advanced Care Planning
- Behavioral/Mental Health Services
- Chronic Care Management
- Complex and Chronic Care - HCPCS Code G2211
- Consultations
- Critical Care Services
- Documentation
- Emergency Department
- Examination
- Fee-For-Time Compensation Arrangements
- General E/M Information
- Global Period Services
- History
- IPPE and AWV Services
- Medical Decision Making
- New vs. Established Patients
- Nonphysician Practitioner Services
- Observation Services
- Preoperative Clearance
- Prolonged Services
- Provider Specialty
- Scribes
- Separately Identifiable Service
- Skilled Nursing Facility Services
- Smoking Cessation
- Split/Shared and Incident To Services
- Teaching Environment E/M Services
- Telehealth Services
- Time-Based Services
- Transitional Care Management
- Urgent Care
Preoperative Clearance
- What requirements must be met for a preoperative clearance visit to be considered medically necessary and billable?
Answer: CMS does not set requirements for medical clearance; these are established by individual hospitals based on current standards of care. However, hospital requirements cannot override Medicare regulations prohibiting screening tests. These visits may be payable by Medicare, but the medical necessity for the clearance must be evident. The necessity is determined by the scope and potential risks of the procedure itself, along with the patient’s general state of health and possible risk factors.
For a patient with a chronic, stable condition(s) who is undergoing a surgical procedure which is not inherently associated with high risk (e.g., cataract surgery), a preoperative clearance may not be medically necessary. Alternatively, that same patient who is undergoing a more complicated procedure (e.g., elective CABG) may require more detailed preoperative evaluation. When a patient has known preoperative risks (e.g., uncontrolled diabetes or poorly controlled hypertension), a preoperative evaluation may be medically necessary.
For major surgical procedures, CMS has calculated the pre-operative services performed by a surgeon as representative of 8% to 17% of the global fee, depending on the type of surgery. Unless there is a valid medical reason for the pre-operative clearance, the service is not covered by Medicare.
Reviewed 10/8/2024