CPT Code 99459Complete Billing & Coding Guide (2026)Pelvic examination
About CPT 99459
CPT 99459 is a Current Procedural Terminology code in the E/M category maintained by the American Medical Association. The CMS short descriptor reads "Pelvic examination". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.
Add-on codes cannot be billed alone and inherit their global period from the primary procedure. Payer scrubbers will reject add-on codes submitted without a valid base code on the same claim.
When billing 99459 with a procedure on the same day, use modifier 25 to indicate a significant, separately identifiable E/M service. Documentation must support the separate work, including a distinct chief complaint or HPI section if applicable.
Code Properties
RVU Breakdown
Every CPT code’s Medicare payment is calculated from three Relative Value Unit components: physician work, practice expense, and malpractice. Together they multiply by the conversion factor to produce the payment amount.
Payment = Total RVU × Conversion Factor ($33.4009) × Geographic Adjustment (GPCI). National averages shown. Actual payment varies by locality.
Medicare Payment by State
Medicare adjusts payment by locality based on GPCI (Geographic Practice Cost Index). Higher cost-of-living areas like California and New York pay more. Rural states pay less. Top 12 states shown.
Showing top 12 of 53 states. Full locality data available in CMS PFS Locality file.
Applicable Modifiers
Modifiers commonly paired with 99459 based on its category. Apply only when the clinical circumstance warrants. Incorrect modifier use is a top audit target.
Modifier 25 on E/M plus same-day procedure is the most-audited modifier in physician billing. UnitedHealthcare, Anthem, and several BCBS plans run automated post-pay review on these claims. We audit every modifier 25 application against the chart before submission.
Find the revenue leakage in your 99459 claims.
Wrong modifier, missing documentation, bundling without justification, stale ICD-10 linkage: these are the silent revenue killers on E/M claims. Our AAPC-certified team audits your last 90 days of 99459 claims, surfaces the recoverable dollars, and appeals them. Free, no obligation.
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Related CPT Codes
Codes in the same family as 99459
Everything about CPT 99459
What does CPT code 99459 cover?
CPT 99459 is a Current Procedural Terminology code in the E/M category maintained by the American Medical Association. The CMS short descriptor reads "Pelvic examination". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.
What is the Medicare payment for CPT 99459?
The national average Medicare payment for CPT 99459 is approximately $17.37 in a non-facility setting and $17.37 in a facility setting. Actual payment varies by locality based on GPCI adjustments. Total RVU is 0.52 with a conversion factor of $33.4009.
What is the global period for CPT 99459?
CPT 99459 is an add-on code (indicator ZZZ). Its global period matches the base procedure it's billed with. Cannot be billed alone. Must be paired with a primary code per CPT guidelines.
CPT codes and descriptions are copyright of the American Medical Association. RVU values reflect current CMS publications. Actual payment varies by locality. Commercial payer rates vary by contract.
Free 90-Day AR Recovery Audit
We audit your last 90 days of claims and surface the revenue leakage: wrong modifiers, missed bundling appeals, ICD-10 specificity gaps. AAPC-certified coders. 2.49% of collections. No setup fees.