Physician Assistant CPT Codes and the ASC Referral Pathway
Physician assistants (PAs) are often the first clinician a patient sees before a procedure reaches an Ambulatory Surgery Center. The PA evaluates the complaint, manages conservative treatment, and decides when a surgical referral is appropriate. That work is documented and billed in the office, so the relevant codes sit in the office and outpatient evaluation and management (E&M) family. New-patient office visits run 99202 through 99205, and established-patient visits run 99211 through 99215; for example, 99203 is a new patient at the low level and 99214 is an established patient at a moderate level.
Because PA office visits are E&M services rather than surgical procedures, they are not on the ASC Covered Procedures List (CMS Addendum AA), which governs what Medicare pays inside the surgical facility. The PA's office E&M is paid separately under the physician fee schedule.
Physician Assistant 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 physician assistants perform procedures inside an ASC?
In a referral or primary-care role, the PA's documented work is usually office-based evaluation and management rather than the surgical procedure itself. The PA assesses the patient, manages conservative care, and refers to a surgeon when appropriate. The office visit is billed under place of service 11, and the surgery is performed and billed separately at the ASC. PAs can practice in surgical settings as well, but the codes mapped to this referral hub are office E&M visits, not ASC procedures.
What CPT codes do physician assistants use for office visits?
The core set is the office and outpatient E&M family. New-patient visits use 99202 through 99205, and established-patient visits use 99211 through 99215. For example, 99202 is a straightforward-level new-patient visit, 99203 is a low-level new-patient visit, 99213 is a low-level established-patient visit, and 99214 is a moderate-level established-patient visit. The level is chosen by medical decision making or total time. Consultation codes may also apply depending on payer rules.
Are physician assistant office visits covered as ASC services?
No. Office E&M visits are not on the ASC Covered Procedures List (CMS Addendum AA), which defines the procedures Medicare pays inside an ASC. A PA's office visit is an evaluation and management service paid under the physician fee schedule and reported with place of service 11, separate from any later ASC facility claim. DataLily's procedure library tracks CPT-specific prior-authorization and documentation requirements so referral and surgical claims stay aligned.