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To introduce the heterogeneous multiscale (HetMS) model for Monte Carlo simulations of gold nanoparticle dose-enhanced radiation therapy (GNPT), a model characterized by its varying levels of detail on different length scales within a single phantom; to apply the HetMS model in two different scenarios relevant for GNPT and to compare computed results with others published. The HetMS model is implemented in EGSnrc; the code is tested via comparisons with published data from independent gold nanoparticle (GNP) simulations. Two distinct scenarios for the HetMS model are considered: (1) monoenergetic photon beams incident on a large cylinder; (2) isotropic point source at the center of a large sphere with GNPs diffusing from the center. Dose enhancement factors (DEFs) are compared for different source energies, depths, gold concentrations, GNP sizes, and modeling assumptions. Simulation efficiencies are investigated. The HetMS MC simulations account for the competing effects of photon fluence perturbation coupled with enhanced local energy deposition. DEFs are most sensitive to these effects for lower source energies, varying with distance from the source; DEFs below unity can occur at energies relevant for brachytherapy. Compared to discrete modeling of GNPs throughout the gold-containing volume, efficiencies are enhanced by up to a factor of 122 with the HetMS approach. For the spherical phantom, DEFs vary with time for diffusion, radionuclide, and radius. By combining geometric models of varying complexity on different length scales within a single simulation, the HetMS model can effectively account for both macroscopic and microscopic effects. Efficiency gains with the HetMS approach enable diverse calculations which would otherwise be prohibitively long. The HetMS model may be extended to diverse scenarios relevant for GNPT, providing further avenues for research and development.