KMAP BULLETIN: Coverage for Add-on Code 99459 Pelvic Examination
Date: 03/03/25
KMAP GENERAL BULLETIN 25014 (PDF)
Effective with dates of service on or after April 1, 2025, CPT code 99459 will be reimbursed as an add-on code when billed with the following specific evaluation and management (E/M) or preventive visit codes for pelvic examinations.
Add-on code 99459 is eligible if billed with:
| Office or Outpatient Visit for New Patient | 99202, 99203, 99204, 99205 |
| Office or Outpatient Visit for Established Patient | 99212, 99213, 99214, 99215 |
| Preventive Visit | 99383, 99384, 99385, 99386, 99387, 99393, 99394, 99395, 99396, 99397 |
Reimbursement:
- The reimbursement for CPT code 99459 is $17.14.
- Reimbursement for CPT code 99459 is limited to pelvic exams for female members only.
Allowable Provider Type/Provider Specialties (PT/PS):
| Provider Type | Provider Specialty |
|---|---|
| 08 – Clinic | 080 – Federally Qualified Health Clinic (FQHC) |
| 081 – Rural Health Clinic (RHC) | |
| 083 – Family Planning Clinic | |
| 181 – Maternity | |
| 09 – Advance Practice Nurse | 093 – Nurse Practitioner (Other) |
| 095 – Certified Nurse Midwife | |
| 10 – Mid-Level Practitioner | 100 – Physician Assistant |
| 13 – Public Health Agency | 181 – Maternity |
| 31 – Physician | 316 – Family Practitioner |
| 318 – General Practitioner | |
| 328 – Obstetrician/Gynecologist | |
| 335 – Maternal Fetal Medicine | |
| 344 – General Internist | |
| 350 – Preventative Medicine | |
| 351 – Indian Health Services |
Note: The rates noted in this bulletin are subject to future changes. Providers should check the Kansas Medical Assistance Program (KMAP) website for the most up-to-date rates.
Note: The effective date of the policy is April 1, 2025. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.