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See a sample rate comparisonCPT 99459 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Pelvic Examination, Pelvic Examination (List Separately In Addition To Code For Primary Procedure)
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Special Evaluation and Management Services |
| Complexity Level | Low |
| Medicare Fee Schedule | $17.37 national non-facility rate (2026) · View Medicare rates for 99459 |
| Medicaid Fee Schedule | $18.355 median of the 8 states in the free preview · View Medicaid rates for 99459 |
National average reimbursement for CPT 99459 by major payers:
$26.17
$41.43
$38.15
$46.78
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CPT 99459
5 of 25 sample ratesHigher to lower in this preview
Agnes Hernandez-Grande
Mass General Brigham Incorporated
$73.23Published rateEast Texas Medical Center Athens
Etx Successor Athens
$36.72Published rateRoberto Martinez
Robert D Martinez Mdpa
$30.60Published ratePaulrajan Manoharan
Renaissance Cardiology Group
$22.69Published rateJorge Martinez-Prieto
Jorge N Martinezprieto Md PA
$20.70Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99459 vs. Other Special Evaluation and Management Services Codes
The CPT 99459 code is part of the Evaluation and Management services used for Special Evaluation and Management Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99459 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99459-CPT | Low | Pelvic Examination, Pelvic Examination (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99459. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99459 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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