General Practice CPT Codes and the ASC Referral Path
General practice is usually a referral source for surgical care, not where surgery happens. A primary care provider evaluates the patient, manages the workup, and refers to an Ambulatory Surgery Center (ASC) when a procedure is indicated. Office visits center on the evaluation and management (E&M) family, CPT 99202 through 99215, with code selection driven by the level of medical decision making or total time on the date of the encounter. So 99213 and 99214 reflect real differences in documented work, not the procedure that may follow.
These office E&M codes are not ASC procedure codes. The referred surgery is billed separately by the operating physician and the facility, and whether Medicare pays it in an ASC depends on the CMS addenda, not on the referring visit.
General Practice 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 general practice procedures done in an ASC?
Generally no. General practice is primary care, and most of its work is office-based evaluation and management billed with place-of-service 11. The PCP usually refers the patient to a specialist or directly to an ASC, where a different physician performs and bills the procedure. The surgical procedure is paid in an ASC only if it appears on the CMS ASC Covered Procedures List (Addendum AA); the referring office visit is billed separately and is not an ASC claim.
What CPT codes does general practice use?
Day-to-day general practice billing centers on the office and outpatient E&M family, CPT 99202-99215. New-patient encounters use 99202-99205 and established-patient encounters use 99211-99215. The specific level, such as 99213 for a low-complexity established visit or 99214 for a moderate-complexity one, is selected based on the documented medical decision making or the total time spent on the date of the encounter.
How do I pick between 99213 and 99214 for an established patient?
Both are established-patient office visits, and the difference is the level of work documented. 99213 corresponds to low-complexity medical decision making, while 99214 corresponds to moderate-complexity decision making. You may also select the level by total time on the date of service. Document the problems addressed, data reviewed, and risk, or the time, so the level you bill matches the note. DataLily's procedure library tracks CPT-specific prior-authorization and documentation requirements to support that work.