• H&P guidelines for Medicare

    Question: Where I can find Medicare guidelines when it comes to history and physicals (H&P) prior to surgery?

    Answer: Medicare requires history and physicals (H&P) for outpatient-based procedures and they must not be performed more than 30 days prior to the date of any scheduled surgical procedure, regardless of the type of procedure (Title 42, Part 416.52(a)(1) of the Code of Federal Regulations). The regulation does not exempt ASCs that perform less invasive procedures from the requirement for a comprehensive H&P. With that being said, you need to find out what level of H&P is typically required by your outpatient facility. The Academy has long advocated that for most cataract surgeries, reducing such preoperative testing could save the program money.