News Briefs

Medicare will now pay for pre-op screenings

Medicare will now pay for preoperative screening and evaluation, provided it is medically necessary, the Centers for Medicare and Medicaid Services (CMS) recently told its carriers.

In its transmittal, CMS clarified that medical preoperative examinations performed by or at the request of the attending surgeon are neither routine screening nor part of the global surgical practice and, with proper documentation, should be paid. CMS left it to physician discretion to determine at which level to code the service and the types of tests that are medically necessary.

"Preoperative medical evaluation is a critical evaluation for Medicare patients, particularly if they have significant illnesses or a multiplicity of medical illnesses," says William G. Plested III, MD, an American Medical Association spokesman. "To improve the safety of operations that can be offered to patients, careful preoperative evaluation with appropriate tests is essential."

Surgeons and anesthesiologists often ask patients to obtain preoperative evaluations from their primary care or other physician to determine whether the patient has additional medical problems that could affect the procedure. However, some Medicare carriers have regularly denied payment for these services by calling them routine screenings. Other carriers denied payment for preoperative screenings, saying it was already included in the payment for the global surgical package. Some carriers also have said Medicare does not permit physicians to run tests on asymptomatic patients to screen for potential problems.