Summary & Overview
HCPCS Level II S0260: Preoperative History and Physical, Outpatient Office
HCPCS Level II code S0260 denotes a preoperative history and physical performed in an outpatient or office setting that is related to a surgical procedure and reported separately from the primary evaluation and management service. Nationally, this code is relevant for documenting distinct preoperative assessments, ensuring clear clinical communication, and supporting appropriate billing for separately identifiable pre-surgical evaluations. Common payers include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
This publication summarizes the clinical purpose of S0260, payer coverage considerations, and the contexts in which the service is typically reported. Readers will find a concise explanation of the service type and typical site of service, an overview of how major national payers treat separate preoperative history and physical services, and reference points for related billing concepts. The document is intended for billing professionals, clinical coders, and policy analysts seeking a national perspective on when and why a distinct preoperative history and physical is reported, and what to expect across major payers. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code S0260 describes a history and physical (outpatient or office) related to a surgical procedure. This service is reported separately in addition to the appropriate evaluation and management service when a distinct preoperative history and physical is performed specifically in relation to a surgery.
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Service type: Preoperative history and physical evaluation
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Typical site of service: Outpatient office or clinic setting
Clinical & Coding Specifications
Clinical Context
A middle-aged patient is referred to an outpatient surgical clinic for preoperative evaluation prior to an elective ambulatory procedure (for example, laparoscopic cholecystectomy or hernia repair). The patient presents to the office or surgical outpatient center for a focused History and Physical related to the planned surgery. The clinic visit is scheduled to document medical history, current medications, allergies, prior anesthesia and surgical history, vital signs, focused systems review, and an assessment of perioperative risk. Relevant preoperative elements include medication reconciliation, review of anticoagulation, cardiopulmonary risk assessment, and determination of medical optimization needs. When applicable, the clinician documents informed consent discussion specific to the planned operation and records clearance requirements or additional testing (e.g., EKG, labs, or cardiology clearance). The encounter is billed in addition to the primary evaluation and management service using S0260 to indicate a distinct history and physical performed specifically for the surgical procedure in the outpatient/office setting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no specific modifier applies to the service |