Internal Medicine in the ASC Referral Pathway
Internal medicine physicians are primary care providers, not operating surgeons. In an ASC network the internist is the referral source: evaluating the patient, managing chronic conditions, and referring to a surgical specialist when a procedure is needed. So the CPT codes mapped to internal medicine in our dataset are office evaluation and management (E&M) visits in the 99202-99215 family, not surgical procedure codes. For example, 99214 covers a moderate established patient visit of 30 to 39 minutes, and 99204 covers a moderate new patient visit of 45 to 59 minutes.
These E&M codes are not on the CMS ASC payment addenda, since they describe office visits rather than facility procedures. The internist's tie to the ASC is the referral and pre-procedure workup, and clean office documentation here supports the downstream surgical claim.
Internal Medicine codes(9)
- 99214Office/outpatient visit, established patient, moderate (30-39 min)
- 99213Office/outpatient visit, established patient, low (20-29 min)
- 99204Office/outpatient visit, new patient, moderate MDM (45-59 min)
- 99202Office/outpatient visit, new patient, straightforward MDM (15-29 min)
- 99203Office/outpatient visit, new patient, low MDM (30-44 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)
Do internal medicine physicians perform procedures in an ASC?
Generally no. Internists are primary care providers who evaluate and manage patients in the office and refer to surgical specialists when a procedure is needed. In an ASC network their role is the referral and pre-procedure workup, not operating in the surgery center. The codes they bill are office visits under place of service 11.
What CPT codes does internal medicine use?
Internal medicine primarily uses office evaluation and management codes in the 99202-99215 range. New patient visits are 99202-99205 and established patient visits are 99211-99215. For example, 99213 is a low-level established patient visit of 20 to 29 minutes and 99204 is a moderate new patient visit. The level is selected by total time or medical decision making.
Are internal medicine office visits covered on the ASC payment list?
Office E&M codes such as 99214 are not on the CMS ASC covered procedures addenda, because those addenda describe facility procedures rather than office encounters. The internist's office visit is billed separately under place of service 11. DataLily's procedure library tracks CPT-specific prior-authorization and documentation requirements so referring and operating teams stay aligned.