CPT 99459 Medicare Fee Schedule 2026
Medicare's 2026 national payment for CPT 99459 is $17.37 in a non-facility setting ($17.37 in a facility), down 16.1% from $20.70 in 2025.
- Non-facility
- $17.37
- Facility
- $17.37
- vs. 2025
- -16.1%
- Commercial national avg.
- $38.13
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| Code | Date | State | Locality | Carrier | Non-Facility Fee | Facility Fee | Description |
|---|---|---|---|---|---|---|---|
| 99459 | 10/2026 | N/A | 00 | 00000 | $17.37 | $17.37 | Pelvic Examination, Pelvic Examination (List Separately In Addition To Code For Primary Procedure) |
| 99459 | 7/2026 | N/A | 00 | 00000 | $17.37 | $17.37 | Pelvic Examination, Pelvic Examination (List Separately In Addition To Code For Primary Procedure) |
| 99459 | 4/2026 | N/A | 00 | 00000 | $17.37 | $17.37 | Pelvic Examination, Pelvic Examination (List Separately In Addition To Code For Primary Procedure) |
| 99459 | 1/2026 | N/A | 00 | 00000 | $17.37 | $17.37 | Pelvic Examination, Pelvic Examination (List Separately In Addition To Code For Primary Procedure) |
| 99459 | 10/2025 | N/A | 00 | 00000 | $20.70 | $20.70 | Pelvic Examination, Pelvic Examination (List Separately In Addition To Code For Primary Procedure) |
| 99459 | 7/2025 | N/A | 00 | 00000 | $20.70 | $20.70 | Pelvic Examination, Pelvic Examination (List Separately In Addition To Code For Primary Procedure) |
| 99459 | 4/2025 | N/A | 00 | 00000 | $20.70 | $20.70 | Pelvic Examination, Pelvic Examination (List Separately In Addition To Code For Primary Procedure) |
| 99459 | 1/2025 | N/A | 00 | 00000 | $20.70 | $20.70 | Pelvic Examination, Pelvic Examination (List Separately In Addition To Code For Primary Procedure) |
99459 national rate by year
Each row is the latest CMS file published that year. Change is against the year before.
| CMS file | Non-facility | Facility | Change |
|---|---|---|---|
| October 2026 | $17.37 | $17.37 | -16.1% |
| October 2025 | $20.70 | $20.70 | -8.5% |
| March 2024 | $22.64 | $22.64 | - |
This is the national amount before geographic adjustment. Medicare multiplies each relative value unit by its locality's geographic practice cost index, so a practice's own allowed amount can be higher or lower; pick a state above to see its localities. The facility amount applies when the service is performed in a hospital or other facility setting.
99459: Medicare vs. commercial national average
The commercial national average for 99459, the mean of what BCBS, UnitedHealthcare, Aetna and Cigna publish nationwide, is $38.13, 220% of Medicare's $17.37.
- BCBS $26.17
- UnitedHealthcare $41.43
- Aetna $38.15
- Cigna $46.78
A national average, not a local rate: each payer's figure averages the unmodified, in-network professional rates it publishes for 99459 across the country in its transparency files. Contracted rates vary widely by market, provider and plan. Medicare's figure is its national non-facility amount before geographic adjustment.
Nearby codes
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See what state Medicaid programs pay for 99459
50 state Medicaid agencies publish their own physician fee schedule. The 99459 page shows real published rates for several of them free, with effective dates and official sources.
17,674 codes and 974,327 published rates, taken from the files the state agencies publish themselves.
Methodology
Rates are sourced directly from CMS Physician Fee Schedule files, indexed quarterly. Non-facility and facility prices are calculated using the published GPCI for each locality and the year's conversion factor.
View CMS Physician Fee Schedule