Primary Care Clinics and CPT Codes in the ASC Referral Network
Primary care clinics are usually the first stop on a patient's path to surgery. In an ASC network the clinic is a referral source, not an operating site: the visit happens in the office and the surgery happens elsewhere, connected by documentation, prior authorization, and a clean referral.
Because the work is evaluation and management rather than surgery, the codes that matter are office E&M codes in the 99202 to 99215 range, such as 99202 for a new patient and 99214 for an established one. Primary care providers do not bill ASC facility or surgical CPT codes; their role is upstream, establishing medical necessity and starting the paperwork that keeps a later claim clean. DataLily's procedure library tracks CPT-specific prior-authorization and documentation requirements, helping referral and surgical teams see early what a downstream procedure will need.
Clinic/Center – Primary Care codes(9)
- 99213Office/outpatient visit, established patient, low (20-29 min)
- 99214Office/outpatient visit, established patient, moderate (30-39 min)
- 99202Office/outpatient visit, new patient, straightforward MDM (15-29 min)
- 99203Office/outpatient visit, new patient, low MDM (30-44 min)
- 99204Office/outpatient visit, new patient, moderate MDM (45-59 min)
- 99205Office/outpatient visit, new patient, high MDM (60-74 min)
- 99211Office/outpatient visit, established patient, minimal
- 99212Office/outpatient visit, established patient, straightforward (10-19 min)
- 99215Office/outpatient visit, established patient, high (40-54 min)
Are primary care services performed in an ASC?
Generally no. Primary care evaluation and management happens in the office under place-of-service 11. The primary care clinic acts as a referral source: it identifies the problem and sends the patient to a specialist or surgeon, who may then perform a procedure at an ambulatory surgery center. The office visit and the surgical procedure are billed separately by different providers.
What CPT codes does primary care use?
Primary care relies mainly on office E&M codes in the 99202 to 99215 range. New patient visits use 99202 through 99205 and established patient visits use 99211 through 99215, with the specific code chosen by the complexity of medical decision making or total time. For example, 99213 covers a lower-complexity established patient visit and 99214 a moderate-complexity one.
How do primary care visits relate to ASC billing?
They sit upstream of it. A primary care office visit documents the symptoms, exam, and clinical reasoning that establish why a referral or procedure is needed. That documentation supports medical necessity and prior authorization for any later ASC procedure, even though the office E&M code itself is billed by the clinic and is not an ASC-covered procedure.