CPT code 99459: Pelvic exam, add-on service2026 Medicare rate & RVUs in Nebraska
Reports a pelvic examination performed during a qualifying evaluation or preventive visit, as an add-on to the primary service.
In Nebraska, Medicare pays $16.03 for 99459 in the office.
Check a contract rate as a % of Medicare · 99459 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 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.
How Nebraska compares for 99459
Across 109 of 109 payment localities, the office rate for 99459 runs from $14.92 in Arkansas to $25.05 in Santa Clara County, CA. Nebraska pays $16.03. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Nebraska · this page$16.03
- Los Angeles, CA · California$20.55+$4.52
- Washington, DC area · District of Columbia$20.46+$4.43
- Miami, FL · Florida$18.08+$2.05
- Chicago, IL · Illinois$17.46+$1.43
- Manhattan, NY · New York$20.18+$4.15
- Alaska · Alaska$18.50+$2.47
Other areas in Nebraska first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $15.20 | — |
| ArkansasArkansas | $14.92 | — |
| ArizonaArizona | $16.83 | — |
| Bakersfield, CACalifornia | $19.04 | — |
| Chico, CACalifornia | $19.04 | — |
| El Centro, CACalifornia | $19.04 | — |
| Fresno, CACalifornia | $19.04 | — |
| Hanford, CACalifornia | $19.04 | — |
| Madera, CACalifornia | $19.04 | — |
| Merced, CACalifornia | $19.04 | — |
| Modesto, CACalifornia | $19.04 | — |
| Napa, CACalifornia | $22.89 | — |
| Oxnard, CACalifornia | $20.53 | — |
| Redding, CACalifornia | $19.04 | — |
| Rest of CaliforniaCalifornia | $19.04 | — |
| Riverside, CACalifornia | $19.04 | — |
| Sacramento, CACalifornia | $20.20 | — |
| Salinas, CACalifornia | $20.13 | — |
| San Diego, CACalifornia | $20.77 | — |
| Marin County, CACalifornia | $24.49 | — |
| San Francisco, CACalifornia | $24.49 | — |
| San Benito County, CACalifornia | $25.05 | — |
| Santa Clara County, CACalifornia | $25.05 | — |
| San Luis Obispo, CACalifornia | $19.78 | — |
| Santa Cruz, CACalifornia | $21.10 | — |
| Santa Maria, CACalifornia | $20.25 | — |
| Santa Rosa, CACalifornia | $21.33 | — |
| Stockton, CACalifornia | $19.04 | — |
| Vallejo, CACalifornia | $22.89 | — |
| Visalia, CACalifornia | $19.04 | — |
| Yuba City, CACalifornia | $19.04 | — |
| ColoradoColorado | $18.48 | — |
| ConnecticutConnecticut | $18.71 | — |
| DelawareDelaware | $17.16 | — |
| Fort Lauderdale, FLFlorida | $17.59 | — |
| Rest of FloridaFlorida | $16.60 | — |
| Atlanta, GAGeorgia | $17.65 | — |
| Rest of GeorgiaGeorgia | $15.49 | — |
| Hawaii, Guam, HIHawaii | $19.75 | — |
| IowaIowa | $15.89 | — |
| IdahoIdaho | $15.98 | — |
| East St. Louis, ILIllinois | $15.98 | — |
| Rest of IllinoisIllinois | $15.86 | — |
| Suburban Chicago, ILIllinois | $17.84 | — |
| IndianaIndiana | $16.10 | — |
| KansasKansas | $15.70 | — |
| KentuckyKentucky | $15.44 | — |
| New Orleans, LALouisiana | $16.34 | — |
| Rest of LouisianaLouisiana | $15.37 | — |
| Metropolitan Boston, MAMassachusetts | $20.74 | — |
| Rest of MassachusettsMassachusetts | $18.29 | — |
| Baltimore area, MDMaryland | $18.64 | — |
| Rest of MarylandMaryland | $17.58 | — |
| Rest of MaineMaine | $15.98 | — |
| Southern Maine, MEMaine | $17.21 | — |
| Detroit, MIMichigan | $16.76 | — |
| Rest of MichiganMichigan | $15.86 | — |
| MinnesotaMinnesota | $17.87 | — |
| Metropolitan Kansas City, MOMissouri | $16.31 | — |
| Metropolitan St. Louis, MOMissouri | $16.53 | — |
| Rest of MissouriMissouri | $14.97 | — |
| MississippiMississippi | $14.95 | — |
| MontanaMontana | $17.37 | — |
| North CarolinaNorth Carolina | $16.20 | — |
| North DakotaNorth Dakota | $17.37 | — |
| New HampshireNew Hampshire | $18.08 | — |
| Northern New JerseyNew Jersey | $20.15 | — |
| Rest of New JerseyNew Jersey | $18.97 | — |
| New MexicoNew Mexico | $15.93 | — |
| NevadaNevada | $17.39 | — |
| NYC suburbs and Long Island, NYNew York | $20.65 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $19.02 | — |
| Queens, NYNew York | $20.53 | — |
| Rest of New YorkNew York | $16.50 | — |
| OhioOhio | $15.86 | — |
| OklahomaOklahoma | $15.51 | — |
| Portland, OROregon | $19.30 | — |
| Rest of OregonOregon | $17.30 | — |
| Metropolitan Philadelphia, PAPennsylvania | $18.08 | — |
| Rest of PennsylvaniaPennsylvania | $15.94 | — |
| Puerto RicoPuerto Rico | $17.56 | — |
| Rhode IslandRhode Island | $17.94 | — |
| South CarolinaSouth Carolina | $16.05 | — |
| South DakotaSouth Dakota | $17.37 | — |
| TennesseeTennessee | $15.79 | — |
| Austin, TXTexas | $18.38 | — |
| Beaumont, TXTexas | $15.81 | — |
| Brazoria, TXTexas | $17.21 | — |
| Dallas, TXTexas | $17.30 | — |
| Fort Worth, TXTexas | $17.13 | — |
| Galveston, TXTexas | $17.25 | — |
| Houston, TXTexas | $17.25 | — |
| Rest of TexasTexas | $16.48 | — |
| UtahUtah | $16.33 | — |
| VirginiaVirginia | $17.07 | — |
| Virgin Islands, VIUnited States Virgin Islands | $17.56 | — |
| VermontVermont | $17.19 | — |
| Rest of WashingtonWashington | $18.29 | — |
| King County, WAWashington | $21.31 | — |
| WisconsinWisconsin | $16.64 | — |
| West VirginiaWest Virginia | $15.09 | — |
| WyomingWyoming | $17.37 | — |
99459 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$14.92
$22.05
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $18.50 | 1 |
| AL | $15.20 | 1 |
| AR | $14.92 | 1 |
| AZ | $16.83 | 1 |
| CA | $19.04–$25.05 | 29 |
| CO | $18.48 | 1 |
| CT | $18.71 | 1 |
| DC | $20.46 | 1 |
| DE | $17.16 | 1 |
| FL | $16.60–$18.08 | 3 |
| GA | $15.49–$17.65 | 2 |
| GU | $19.75 | 1 |
| HI | $19.75 | 1 |
| IA | $15.89 | 1 |
| ID | $15.98 | 1 |
| IL | $15.86–$17.84 | 4 |
| IN | $16.10 | 1 |
| KS | $15.70 | 1 |
| KY | $15.44 | 1 |
| LA | $15.37–$16.34 | 2 |
| MA | $18.29–$20.74 | 2 |
| MD | $17.58–$20.46 | 3 |
| ME | $15.98–$17.21 | 2 |
| MI | $15.86–$16.76 | 2 |
| MN | $17.87 | 1 |
| MO | $14.97–$16.53 | 3 |
| MS | $14.95 | 1 |
| MT | $17.37 | 1 |
| NC | $16.20 | 1 |
| ND | $17.37 | 1 |
| NE | $16.03 | 1 |
| NH | $18.08 | 1 |
| NJ | $18.97–$20.15 | 2 |
| NM | $15.93 | 1 |
| NV | $17.39 | 1 |
| NY | $16.50–$20.65 | 5 |
| OH | $15.86 | 1 |
| OK | $15.51 | 1 |
| OR | $17.30–$19.30 | 2 |
| PA | $15.94–$18.08 | 2 |
| PR | $17.56 | 1 |
| RI | $17.94 | 1 |
| SC | $16.05 | 1 |
| SD | $17.37 | 1 |
| TN | $15.79 | 1 |
| TX | $15.81–$18.38 | 8 |
| UT | $16.33 | 1 |
| VA | $17.07–$20.46 | 2 |
| VI | $17.56 | 1 |
| VT | $17.19 | 1 |
| WA | $18.29–$21.31 | 2 |
| WI | $16.64 | 1 |
| WV | $15.09 | 1 |
| WY | $17.37 | 1 |
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.
The exact Nebraska inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
13,126
- Code
- 99459
- Physician work
- 0.00
- Practice expense
- 0.52
- Malpractice
- 0.00
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.000 | 0.0000 |
| Practice expense | 0.52 | × 0.923 | 0.4800 |
| Malpractice | 0.00 | × 0.378 | 0.0000 |
| Total RVUs | 0.4800 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Nebraska$16.03
Office: (0 × 1 + 0.52 × 0.923 + 0 × 0.378) × $33.4009 = $16.03
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. |
How 99459 has changed in Nebraska
99459 · Office / nonfacility
$16.03
Effective 2026-10-01
The base rate is $2.95 lower than on 2025-10-01, moving from $18.98 to $16.03 (15.5%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$18.98changed to$16.03
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 0.64 changed to 0.52
- Practice expense GPCI 0.917 changed to 0.923
- Malpractice GPCI 0.304 changed to 0.378
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$20.76changed to$18.98
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 0.68 changed to 0.64
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$20.42changed to$20.76
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
No ratechanged to$20.42
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D, RVU22A, RVU22B, RVU22C, RVU22D, RVU23A, RVU23B, RVU23C, RVU23D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $16.03 | Not available in this setting | RVU26D |
| 2026-07-01 | $16.03 | Not available in this setting | RVU26C |
| 2026-04-01 | $16.03 | Not available in this setting | RVU26B |
| 2026-01-01 | $16.03 | Not available in this setting | RVU26A |
| 2025-10-01 | $18.98 | Not available in this setting | RVU25D |
| 2025-07-01 | $18.98 | Not available in this setting | RVU25C |
| 2025-04-01 | $18.98 | Not available in this setting | RVU25B |
| 2025-01-01 | $18.98 | Not available in this setting | RVU25A |
| 2024-10-01 | $20.76 | Not available in this setting | RVU24D |
| 2024-07-01 | $20.76 | Not available in this setting | RVU24C |
| 2024-04-01 | $20.76 | Not available in this setting | RVU24B |
| 2024-03-09 | $20.76 | Not available in this setting | RVU24AR |
| 2024-01-01 | $20.42 | Not available in this setting | RVU24A |
| 2023-10-01 | Not in this release | Not in this release | RVU23D |
| 2023-07-01 | Not in this release | Not in this release | RVU23C |
| 2023-04-01 | Not in this release | Not in this release | RVU23B |
| 2023-01-01 | Not in this release | Not in this release | RVU23A |
| 2022-10-01 | Not in this release | Not in this release | RVU22D |
| 2022-07-01 | Not in this release | Not in this release | RVU22C |
| 2022-04-01 | Not in this release | Not in this release | RVU22B |
| 2022-01-01 | Not in this release | Not in this release | RVU22A |
| 2021-10-01 | Not in this release | Not in this release | RVU21D |
| 2021-07-01 | Not in this release | Not in this release | RVU21C |
| 2021-04-01 | Not in this release | Not in this release | RVU21B |
| 2021-01-01 | Not in this release | Not in this release | RVU21A |
| 2020-10-01 | Not in this release | Not in this release | RVU20D |
| 2020-07-01 | Not in this release | Not in this release | RVU20C |
| 2020-04-01 | Not in this release | Not in this release | RVU20B |
| 2020-01-01 | Not in this release | Not in this release | RVU20A |
| 2019-10-01 | Not in this release | Not in this release | RVU19D |
| 2019-07-01 | Not in this release | Not in this release | RVU19C |
| 2019-04-01 | Not in this release | Not in this release | RVU19B |
| 2019-01-01 | Not in this release | Not in this release | RVU19A |
| 2018-10-01 | Not in this release | Not in this release | RVU18D |
| 2018-07-01 | Not in this release | Not in this release | RVU18C |
| 2018-04-01 | Not in this release | Not in this release | RVU18B |
| 2018-01-01 | Not in this release | Not in this release | RVU18AR1 |
| 2017-10-01 | Not in this release | Not in this release | RVU17D |
| 2017-07-01 | Not in this release | Not in this release | RVU17C |
| 2017-04-01 | Not in this release | Not in this release | RVU17B |
| 2017-01-01 | Not in this release | Not in this release | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Nebraska rate applies
Nebraska is a Medicare payment area, not a city. Our Census mapping connects it to 593 cities and communities in Nebraska. Some span more than one payment area; confirm with the service ZIP.
- Abie
- Adams
- Agnew
- Ainsworth
- Albion
- Alda
- Alexandria
- Allen
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
Show the CMS file lines behind this rate
Fee sheets · Coming soon
Put 99459 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist