Primary care practices are frequently asked to do preoperative evaluations or clearances on their own patients by a surgeon. Although a routine history and physical mandated by the hospital is included in the surgical payment, patients may need an evaluation by their primary care clinician, a cardiologist, pulmonologist, or other practitioner prior to surgery. These medically necessary preoperative evaluations are paid by Medicare and insurance companies, although many PCPs question the medical necessity of some of these evaluations.