CPT code 99459 is an add-on code for a pelvic examination performed during an office visit. The CPT Editorial Panel created it in 2022, and Medicare has recognized it since January 1, 2024. It pays only for the practice's direct expenses of the exam, such as clinical staff time chaperoning the patient, because the physician's work is already paid through the visit code it is added to. It is never billed on its own.
The code is not about remote patient monitoring. Earlier versions of this page described it that way, which was wrong. Remote physiologic monitoring has its own codes, covered below.
The Medicare rules here come from CMS's fee schedule files and edits. Other payers decide separately whether they recognize 99459, so check the payer's policy. Payment varies by payer and locality; for Medicare, use the Physician Fee Schedule look-up.
What does 99459 pay for?
In the CY 2024 Physician Fee Schedule final rule, CMS explains that the specialty societies and the CPT Editorial Panel agreed the physician work of a pelvic exam is captured in the visit code. So 99459 is a practice-expense-only code: it carries no physician work value and covers the direct costs of performing the exam in a non-facility setting, including four minutes of clinical staff time for chaperoning.
In the 2026 Medicare fee schedule file, 99459:
- has an active status, so Medicare pays it separately when the service is covered
- has no work RVUs, only a practice expense value
- has a practice expense value only in the non-facility setting, such as a physician's office; the facility value is marked "NA", meaning CMS considers the service rarely or never performed there
- carries a ZZZ global indicator, which marks an add-on code reported with another service
Which codes can 99459 be added to?
CMS's add-on code edit file lists the primary codes Medicare accepts with 99459 (effective January 1, 2024):
| Primary codes | What they are |
|---|---|
| 99202–99205, 99212–99215 | New and established patient office visits (not 99211) |
| 99242–99245 | Office or outpatient consultations |
| 99383–99387, 99393–99397 | Preventive medicine visits for new and established patients, by age band |
| G0463 | Hospital outpatient clinic visit |
Being on this list doesn't make the primary service payable. Medicare doesn't cover routine preventive medicine visits, which carry a non-covered status in the fee schedule file, and it doesn't recognize the office consultation codes 99242–99245 for Part B payment; CMS tells practices to bill the appropriate E/M visit code instead. Check the primary service first, then add 99459 when a pelvic exam was performed and documented.
What should the record show?
- that a pelvic exam was performed at the visit, and its findings
- the visit itself, documented and coded at the level the record supports (see the guides to 99214 and 99203)
- where your policy or the payer requires it, that a chaperone was present
Don't add 99459 by default to every visit for a particular specialty or visit type. It is reported only when the exam was done.
How is 99459 different from G0101?
Medicare has a separate HCPCS code, G0101, for a covered screening pelvic and clinical breast exam. It is a screening benefit with its own frequency limits: generally once every 24 months (at least 23 months after the last covered screening exam), or more often for beneficiaries who meet Medicare's conditions for more frequent screening. The claim must point to a diagnosis code showing the patient's low- or high-risk status.
Medicare also allows a separately identifiable E/M visit on the same day as G0101, with modifier 25 on the visit and documentation that supports it.
Which code applies depends on why the exam was done: a screening exam under Medicare's benefit, or an exam that is part of a problem-oriented or preventive visit. Whether 99459 is also payable alongside G0101 isn't addressed in the sources above; confirm with your Medicare Administrative Contractor (MAC).
Which codes cover remote patient monitoring?
Remote physiologic monitoring (RPM) is the remote monitoring of readings such as weight, blood pressure and pulse oximetry to manage a patient's condition. It is reported with its own CPT codes: 99453 for initial setup, 99454 and, from 2026, 99445 for the device supply depending on the number of days of readings in a 30-day period, and 99457, 99458 and, from 2026, 99470 for treatment management time. CMS finalized the 2026 changes in the CY 2026 Physician Fee Schedule final rule. None of them relate to 99459.
Highview bills office visits and their add-on codes through its physician billing service.
Sources
- Federal Register, CY 2024 Physician Fee Schedule final rule, 88 FR 78911–78912: creation of 99459 as a practice-expense-only code, chaperone time, no facility practice expense.
- CMS, PFS Relative Value Files, RVU26D: 2026 status, RVUs, facility indicator and global indicator for 99459 and G0101; status of preventive medicine codes; definitions of status codes and the NA indicator.
- CMS, Medicare NCCI Add-on Code Edits (effective October 1, 2026): primary codes for 99459.
- CMS, Evaluation and Management Services Guide, MLN006764 (May 2026): Medicare doesn't recognize the consultation codes for Part B payment.
- CMS, Medicare Claims Processing Manual, Chapter 18, section 40: screening pelvic examinations, frequency, diagnosis pointers, G0101 with a same-day E/M visit.
- Federal Register, CY 2026 Physician Fee Schedule final rule, 90 FR 49266: remote monitoring codes, including new codes 99445 and 99470.
- CMS, Search the Physician Fee Schedule.