Billing for Pre-op

September 1, 2004

We see some of our regular patients for preoperative clearance. How can we get Medicare to pay?

Question: We see some of our regular patients for preoperative clearance. How can we get Medicare to pay?

Answer: Medicare will pay for preoperative clearance exams if the exam is medically necessary and meets the documentation requirements of the service billed. Usually, you'd use an E&M code. If you are getting denials, you can try printing out the following transmittal - look at pages 5 and 6 - which spells out Medicare's policy:

www.cms.hhs.gov/manuals/pm_trans/R1707B3.pdf.

Attach this to your appeal - in addition to the written request from the surgeon - and you should get paid.