CPT code 99459: Pelvic exam, add-on service2026 Medicare rate & RVUs in Maine
Reports a pelvic examination performed during a qualifying evaluation or preventive visit, as an add-on to the primary service.
Medicare pays $15.98–$17.21 for 99459 in the office in Maine, from Rest of Maine to Southern Maine, ME. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Maine
| Payment locality | Office | Facility |
|---|---|---|
| Rest of Maine | $15.98 | Unavailable |
| Southern Maine, ME | $17.21 | Unavailable |
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.
How the rate is built · 99459
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.52
0.52 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.5200
Conversion factor
$33.4009
Medicare rate
$17.37
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99459
The CMS indicators that decide how 99459 is paid alongside other services.
CMS payment indicators · 99459
Pelvic exam, add-on service
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
99459 compared with similar codes
Compare codes · National
4 codes, side by side
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.
99459 billing questions
Can 99459 be billed by itself?
No. It is an add-on and must be reported with an eligible primary service, such as an applicable office or outpatient E/M or preventive medicine service.
Which primary services commonly pair with 99459?
Common pairings include office or outpatient E/M codes 99202–99205 and 99212–99215, and preventive medicine codes 99384–99387 and 99394–99397.
What documentation supports 99459?
Document that the pelvic examination was performed and describe the examination elements. The record must also support the primary service reported.
Is 99459 reported by time or as multiple units?
It is not a time-based service. Report it for the pelvic examination performed with the qualifying primary service, rather than counting minutes.
Does 99459 replace the primary E/M or preventive code?
No. The primary service reports the visit; 99459 is an add-on for the pelvic examination performed during that visit.
Does the add-on have its own global-period payment treatment?
CMS treats 99459 as payable within the global period of its required primary procedure, so it must accompany that service.
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
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