CPT code 99459: Pelvic exam, add-on service2026 Medicare rate & RVUs

Medicare pays $17.37 for 99459 nationally in the office. Local office rates run $14.92–$25.05.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99459 covers

Code 99459 captures a pelvic examination, such as examination with a speculum and bimanual assessment, performed during a qualifying visit. It is commonly used by gynecologists, primary care clinicians, and other practitioners who assess pelvic or reproductive health in office and outpatient settings. The examination may occur during a problem-oriented visit or a preventive visit when the clinician performs and documents it.

Report 99459 only with an eligible primary service, including applicable office or outpatient E/M and preventive medicine services. The record should identify the examination performed and support the primary service billed; the add-on is not a stand-alone visit or a time-based service. CMS pays it within the primary procedure’s global-period framework. The code has practice-expense value but no physician-work or malpractice value.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 99459 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99459 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99459 rate is calculated

Each of 99459’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99459

The CMS indicators that decide how 99459 is paid alongside other services.

99459 compared with similar codes

How to choose

99213Office visitEstablished patient, low complexity

99213 reports an established-patient office or outpatient E/M service. Add 99459 only when a pelvic examination is also performed and documented.

99395Preventive visitEstablished, age 18-39

99395 reports an established-patient preventive medicine service. It may serve as the primary code for 99459 when a pelvic examination is performed.

99202New patient visitStraightforward MDM or 15 minutes

99202 reports a new-patient office or outpatient E/M service, not the pelvic examination add-on. 99459 may accompany it when the examination is performed.

Codes related to 99459

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates