Medicare Reimbursement for History and Physical (H&P)

A comprehensive history and physical (H&P) exam is done to determine, before the surgery, whether there is anything in the patient’s overall condition that would affect the conduct of the planned procedure, or which may even require cancellation of the procedure.

As a general rule, a H&P is not performed within the ASC due to time constraints, limitations of the state facility license, a desire to be reimbursed for this work, and the presumption that an exam within the ASC is probably the required pre-anesthesia assessment of the anesthetist or the pre-surgical evaluation by the surgeon – neither is separately reimbursed.

This FAQ addresses the following:

1. What is a H&P, and why is it performed?
2. Where is the H&P performed, and when?
3. Who may perform the H&P before eye surgery?
4. May a H&P be performed on same day the surgeon makes the decision for surgery?
5. Is a H&P part of the global surgery package if it is done by the surgeon?
6. What ICD codes apply?
7. What is the typical level of service for a H&P?
8. How is the H&P different from the anesthetist’s pre-anesthesia exam?
9. What’s the difference between a H&P and a pre-surgical evaluation?

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