CPT 99459 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Evaluation and Management • Special Evaluation and Management Services |
| Common Place of Service | |
| Common Modifiers | |
| Complexity Level | Moderate |
National average reimbursement for CPT 99459 by major payers:
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| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99459 | ||||||
United | 99459 | $46.86 | 1235471657 - JOEL INGRIM | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99459 | $17.43 | 1366678963 - BRIAN COOPER | 473666260 - (MS) CURANA HEALTH OF MISSISSIPPI LLC | TX | Internal Medicine Physician (207R00000X) |
United | 99459 | $20.70 | 1528061488 - FEDERICO NG | 742956482 - (TX) FEDERICO ROMAN NG MDPA | TX | Internal Medicine Physician (207R00000X) |
United | 99459 | $28.00 | 1780836429 - DEEPIKA KILARU | 463934006 - (TX) DEEPIKA KILARU MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99459 | $23.79 | 1972548642 - TOEPPERWEIN MED-CLINIC LTD, TOEPPERWEIN MEDICAL CLINIC LTD | 742855814 - (TX) NADINE LIU, D.O., P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99459 | $20.86 | 1366637332 - MOIZ SHAFIQ | 824400223 - (TX) DALLAS CARDIOLOGY PLLC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99459 | $32.40 | 1437218807 - CARLOS MEZA | 452498998 - (TX) ADULT INPATIENT MEDICAL SERVICES | TX | Internal Medicine Physician (207R00000X) |
United | 99459 | $20.86 | 1285656207 - PEDRO CHECO | 752968819 - (TX) PRESTON MEDICAL ASSOCIATES PA | TX | Internal Medicine Physician (207R00000X) |
United | 99459 | $36.72 | 1356320873 - EAST TEXAS MEDICAL CENTER ATHENS | 751854562 - (TX) ETX SUCCESSOR ATHENS | TX | General Acute Care Hospital (282N00000X) |
United | 99459 | $37.90 | 1285697656 - WILDER DIAZ-CALDERON | 710892430 - (TX) TEXAS HEALTH CARE, P.L.L.C. | TX | Internal Medicine Physician (207R00000X) |
United | 99459 | $26.95 | 1245234293 - ANTHONY AGOSTINI | 200241221 - (TX) CARDIOLOGY CENTER OF AMARILLO, LLP | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99459 | $67.97 | 1356335004 - JAMES WHITMAN | 43165789 - (MA) FRAMINGHAM PEDIATRICS, P.C. | MA | Pediatrics Physician (208000000X) |
United | 99459 | $24.54 | 1619164852 - YOLANDA AJALA | 834479426 - (TX) CDVA PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99459 | $19.48 | 1114120631 - JOANNA IRA | 760009637 - (TX) LEGACY COMMUNITY HEALTH SERVICES INC | TX | Internal Medicine Physician (207R00000X) |
United | 99459 | $37.91 | 1851898704 - HASSAN ASGHAR | 742109824 - (TX) AUSTIN REGIONAL CLINIC PA | TX | Internal Medicine Physician (207R00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 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 | Moderate | 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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