CPT 99459 Pelvic Examination Billing for Medicare

National Government Services has received several inquiries regarding the use of CPT 99459, which was added to CPT coding for 2024 as an add-on code service. This means the code is only payable if provided and billed on the same day, on the same claim, as the appropriate service(s) allowed per coding guidelines.

CPT 99459 is a work expense only add-on code. It’s for four minutes of clinical time chaperoning a pelvic exam as well as the supply pack. If a pelvic exam or pap/pelvic is provided, these services are bundled into the service. This code would be used when the patient is receiving an E/M level service and the physician feels it is necessary to do a pelvic exam as part of the service that day. The office/other outpatient E/M codes are the only services on this list billable to Medicare.

CPT has clearly defined this add-on code can only be billed with 99202-99205, 99212-99215, 99242-99245, 99383-99387, 99393-99397.

CPT 99383-99387 and 99393-99397 are actual examination services and are appropriate for this add-on code for payers other than Medicare.

This service would not be an add-on code for an annual wellness visit because it’s not a medical examination or procedure, therefore, add-on guidelines would not apply.

Posted 5/23/2024