$90.59–$97.77
99213 reports an established-patient office or outpatient E/M service. Add 99459 only when a pelvic examination is also performed and documented.
On this page
CMS RVU26D · Effective 2026-10-01
99459 Pelvic exam Medicare reimbursement rates in Texas
Reports a pelvic examination performed during a qualifying evaluation or preventive visit, as an add-on to the primary service. Compare 99459 office and facility rates across CMS payment localities in Texas.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99459 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
$15.81–$18.38
8 of 8 localities have a supported rate.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 99459 pays more and less in Texas
8 payment localities
$15.81 to $18.38
Gynecology
About 99459: Pelvic examination add-on
Reports a pelvic examination performed during a qualifying evaluation or preventive visit, as an add-on to the primary service.
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. In the supplied RVU facts, the code has practice-expense value but no physician-work or malpractice value.
CMS billing rules for 99459
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU0.00 · 0%
- Practice expense (office) RVU0.52 · 100%
- Malpractice RVU0.00 · 0%
272.3K
Medicare services in 2024 · #330 by national volume
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.
99459 compared with similar codes
Office rates for Texas, from the same CMS release.
99395
No office ratePrev visit est 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.
$71.23–$77.37
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.
Compare 99459 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office $18.38 | Facility Unavailable |
| Beaumont | Office $15.81 | Facility Unavailable |
| Brazoria | Office $17.21 | Facility Unavailable |
| Dallas | Office $17.30 | Facility Unavailable |
| Fort Worth | Office $17.13 | Facility Unavailable |
| Galveston | Office $17.25 | Facility Unavailable |
| Houston | Office $17.25 | Facility Unavailable |
| Rest Of Texas | Office $16.48 | Facility Unavailable |
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,12399456,,Disability examination,R,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,12499457,,Rpm tx mgmt 1st 20 min,A,,0.61,0.90,,0.14,,0.04,1.55,0.79,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,12599458,,Rpm tx mgmt ea addl 20 min,A,,0.61,0.59,,0.14,,0.04,1.24,0.79,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,12699459,,Pelvic examination,A,,0.00,0.52,,0.52,NA,0.00,0.52,0.52,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,12799460,,Init nb em per day hosp,A,,1.92,0.38,NA,0.38,,0.12,2.42,2.42,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,12899461,,Init nb em per day non-fac,A,,1.26,1.48,,0.26,,0.07,2.81,1.59,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,12999462,,Sbsq nb em per day hosp,A,,0.84,0.17,NA,0.17,,0.05,1.06,1.06,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00