# CPT 99459: Pelvic Examination

Medicare CPT 99459 pays $17.37 in a non-facility setting and $17.37 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $14.92 in Arkansas to $20.55 in California, a 38% spread.

Web page: https://www.med-reveal.com/rates/99459-cpt-fee-schedule
Section: Evaluation and Management
Billed by: Evaluation

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $17.37 |
| National facility | $17.37 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| California | $20.55 | $20.55 |
| District of Columbia | $20.46 | $20.46 |
| Washington | $19.80 | $19.80 |
| Hawaii | $19.75 | $19.75 |
| New Jersey | $19.56 | $19.56 |
| Massachusetts | $19.52 | $19.52 |
| New York | $19.38 | $19.38 |
| Connecticut | $18.71 | $18.71 |
| Alaska | $18.50 | $18.50 |
| Colorado | $18.48 | $18.48 |
| Oregon | $18.30 | $18.30 |
| Maryland | $18.11 | $18.11 |
| New Hampshire | $18.08 | $18.08 |
| Rhode Island | $17.94 | $17.94 |
| Minnesota | $17.87 | $17.87 |
| Puerto Rico | $17.56 | $17.56 |
| Virgin Islands | $17.56 | $17.56 |
| Florida | $17.42 | $17.42 |
| Nevada | $17.39 | $17.39 |
| Montana | $17.37 | $17.37 |
| North Dakota | $17.37 | $17.37 |
| South Dakota | $17.37 | $17.37 |
| Wyoming | $17.37 | $17.37 |
| Vermont | $17.19 | $17.19 |
| Delaware | $17.16 | $17.16 |
| Texas | $17.10 | $17.10 |
| Virginia | $17.07 | $17.07 |
| Pennsylvania | $17.01 | $17.01 |
| Arizona | $16.83 | $16.83 |
| Illinois | $16.79 | $16.79 |
| Wisconsin | $16.64 | $16.64 |
| Maine | $16.60 | $16.60 |
| Georgia | $16.57 | $16.57 |
| Utah | $16.33 | $16.33 |
| Michigan | $16.31 | $16.31 |
| North Carolina | $16.20 | $16.20 |
| Indiana | $16.10 | $16.10 |
| South Carolina | $16.05 | $16.05 |
| Nebraska | $16.03 | $16.03 |
| Idaho | $15.98 | $15.98 |
| Missouri | $15.94 | $15.94 |
| New Mexico | $15.93 | $15.93 |
| Iowa | $15.89 | $15.89 |
| Louisiana | $15.86 | $15.86 |
| Ohio | $15.86 | $15.86 |
| Tennessee | $15.79 | $15.79 |
| Kansas | $15.70 | $15.70 |
| Oklahoma | $15.51 | $15.51 |
| Kentucky | $15.44 | $15.44 |
| Alabama | $15.20 | $15.20 |
| West Virginia | $15.09 | $15.09 |
| Mississippi | $14.95 | $14.95 |
| Arkansas | $14.92 | $14.92 |

## Related codes

- 99201: New Patient Office Visit: Coverage and Documentation Requirements — https://www.med-reveal.com/rates/99201-cpt-fee-schedule
- 99241: Office consultation for a new or established patient that requires these three key components: a problem-focused history; a problem-focused examination; and straightforward medical decision-making — https://www.med-reveal.com/rates/99241-cpt-fee-schedule
- 99251: Inpatient consultation for a new or established patient which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. — https://www.med-reveal.com/rates/99251-cpt-fee-schedule
- 99288: Phys/qhp Direction Emergency Medical Systems — https://www.med-reveal.com/rates/99288-cpt-fee-schedule
- 99354: Prolonged Service With Direct Patient Contact — https://www.med-reveal.com/rates/99354-cpt-fee-schedule
- 99355: Prolonged Service With Direct Patient Contact — https://www.med-reveal.com/rates/99355-cpt-fee-schedule
- 99358: Prolng E/m Svc Before&/after Dir Pt Care 1st Hr — https://www.med-reveal.com/rates/99358-cpt-fee-schedule
- 99359: Prolng E/m Before&/after Dir Care Ea 30 Minutes — https://www.med-reveal.com/rates/99359-cpt-fee-schedule

Commercial negotiated rates for 99459 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules