CPT Code 99459: What You Need to Know About This New Pelvic Exam Add-On
In September 2022, the CPT Editorial Panel created a new Current Procedural Terminology (CPT) code for reporting a pelvic exam. In the 2024 CPT code book —CPT code 99459 pelvic examination is to be listed separately in addition to the primary procedure code (add-on code). This new CPT code can be found on page 62 in the E/M section, not in the Female Genital System 5000 section. A patient’s medical history, current symptoms, or results should result in a discussion between the patient and their obstetrician, gynecologist, or other gynecologic care professional prior to completing a pelvic examination.
A pelvic examination is recommended when indicated by a patient’s medical history, present symptoms, or test outcomes
For CPT code 99459, primary procedure codes will be represented with Evaluation and Management (E/M) codes that represent Office or Other Outpatient new and established patients 99202-99215 consultation 99242-99245 and preventative visits (99383-99397).
CPT code 99459 (Pelvic Exam) captures the 4 minutes of clinical staff time associated with chaperoning a pelvic exam. Which should not be included when billing an Office or Other Outpatient E/M visit based on time, nor in the data section when selecting the level of MDM.
Layman terms: If a pelvic examination is completed in an Office or Other Outpatient services, visit a new or established patient who is seen for a regular office, consultation, or preventative visit. A pelvic examination is a separately billable service. When a chaperone is present and noted in the patient progress note, The pelvic exam is not counted as an element in MDM or Time.
