Nurse Practitioner CPT Codes and the ASC Referral Path
Nurse practitioners (NPs) are a common front door to ambulatory surgery, usually acting as the referring primary care provider. They evaluate the patient in the office, document the problem, order workup, and refer to the surgeon who performs the procedure at the ASC. Their billing footprint is built almost entirely on office evaluation and management (E&M) codes.
Our dataset maps 9 ASC-relevant CPT codes to the NP role, drawn from the office E&M family 99202-99215 and coded with place of service 11 (office). For example, 99213 covers established-patient follow-up, and 99202 covers the new-patient evaluation that often starts a surgical referral. The office E&M is a separate professional service from the procedure billed at the surgery center. DataLily's procedure library tracks CPT-specific prior-authorization and documentation requirements, helping referring clinics align their office notes with what the downstream surgeon and ASC will need.
Nurse Practitioner 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)
Do nurse practitioners perform procedures in an ASC?
In this referral model, the nurse practitioner is generally the referring clinician rather than the surgeon. The NP evaluates and manages the patient in the office and refers to a surgeon who performs the case at the ASC. The codes mapped to the NP role here are office E&M codes, not surgical procedure codes.
What CPT codes do nurse practitioners use?
For the ASC referral pathway, the relevant family is office evaluation and management, 99202-99215. New-patient visits like 99202 and 99203 cover initial evaluations, and established-patient visits like 99213 and 99214 cover follow-up and ongoing management. These are reported with place of service 11.
Why is the NP visit billed under place of service 11 instead of the ASC?
The office E&M service is furnished in the clinic before or after the surgical encounter, so it carries place of service 11 (office). The procedure itself is billed separately by the surgeon, and the facility fee is billed by the ambulatory surgery center under the ASC place of service. They are distinct claims for distinct services.