MedicaidBilling CodesMedium impact
KMAP BULLETIN: Coverage for Add-on Code 99459 Pelvic Examination
Kansas Medicaid (KanCare)·KS · Family Medicine, OB-GYN, Internal Medicine +1 more·Coding
Effective date
Apr 1, 2025
We identified it
Jun 21, 2026
Summary
Effective April 1, 2025, Kansas Medicaid will reimburse CPT code 99459 as an add-on code for pelvic examinations when billed with specific E/M or preventive visit codes. The reimbursement rate is $17.14 and is limited to female patients only.
Action Required
By April 1, 2025: Billing team must update system to allow CPT code 99459 as an add-on code for pelvic exams with specified E/M and preventive visit codes for Kansas Medicaid patients. Update encounter forms to include 99459 for eligible providers (family medicine, OB/GYN, internal medicine, nurse practitioners, physician assistants). Ensure billing is limited to female patients only. Configure system for $17.14 reimbursement rate.