MAC demand: Medical necessity controls coverage of preop E/M visits

Why This Topic Matters

Preoperative visits can be denied or shift cost to the patient if the encounter is not supported as medically necessary. Understanding how Medicare contractors view these services helps practices document appropriately, reduce denials, and avoid preventable patient liability.

Article Sections

1. Medical necessity and preoperative clearance

   Overview of how Medicare coverage is affected when a preoperative clearance or similar visit is performed before surgery. Includes general discussion of contractor scrutiny and the role of documentation.

2. When a provider performs a preoperative clearance

   Discussion of situations involving separate preoperative clearances and how contractor guidance addresses medically necessary versus routine encounters. Covers the broad factors considered in review and the related diagnostic reporting framework.

3. The surgeon performs the preoperative visit

   Explains contractor review of additional preoperative visits performed by the surgeon and the importance of documenting the reason for the encounter. Also addresses timing, changes in patient status, and the relevance of the work performed.

4. Resources

   Lists referenced external guidance and official sources supporting the article's topic.