Family Medicine and the ASC Referral Pathway
Family Medicine is a referral source, not an operating specialty, so the CPT codes mapped here are office evaluation and management (E&M) visits in the 99202-99215 range, not surgical codes. New patient visits like 99202 (straightforward, 15-29 minutes) and established visits like 99214 (moderate, 30-39 minutes) cover the assessments and pre-referral conversations that route a patient toward an ASC. We map 9 ASC-relevant CPT codes to this specialty.
These office visits are paid under the Medicare Physician Fee Schedule, not the ASC payment system, so they do not appear on CMS Addendum AA, the ASC Covered Procedures List that governs which surgical codes Medicare pays in an ASC. DataLily's procedure library tracks CPT-specific prior-authorization and documentation requirements, keeping the referring office and receiving ASC aligned on what a payer will expect.
Family Medicine codes(9)
- 99213Office/outpatient visit, established patient, low (20-29 min)
- 99214Office/outpatient visit, established patient, moderate (30-39 min)
- 99203Office/outpatient visit, new patient, low MDM (30-44 min)
- 99202Office/outpatient visit, new patient, straightforward MDM (15-29 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 Family Medicine procedures done in an ASC?
Family Medicine is primarily an office-based, referral specialty. The PCP evaluates and manages the patient in the office (place of service 11) and refers to a surgical specialist when a procedure is indicated. The surgery itself is performed and billed by the operating specialist at the ASC, not by the Family Medicine physician.
What CPT codes does Family Medicine use?
Family Medicine relies mainly on office E&M codes in the 99202-99215 range. New patient visits run 99202 through 99205 (for example, 99202 for straightforward MDM and 99203 for low complexity), and established patient visits run 99211 through 99215 (such as 99213 and 99214). These describe the visit by complexity and time.
Does Medicare pay Family Medicine office visits under the ASC payment system?
No. Office E&M visits are paid under the Medicare Physician Fee Schedule based on place of service 11, not the ASC payment system. Codes on CMS Addendum AA are the surgical procedures Medicare pays in an ASC. The PCP's office visits sit outside that list, while a referred surgical case may be covered under it.