Insurer stops paying separately for pelvic exams with E/M visits

Health insurer Cigna has decided to stop allowing clinicians to bill separately for CPT code 99459 when they perform pelvic exams during evaluation and management (E/M) visits.

99459 is an add-on code CPT introduced in 2024 for practices to report when the patient presents for an E/M visit and the physician or other clinician feels it is necessary to perform a pelvic exam. But Cigna recently updated its reimbursement policy R30 “Evaluation and Management Services,” and as of June 1 the company considers 99459 included in the office visit E/M service codes (99202-99205 and 99212-99215).

Next steps for your practice

If your practice has been reporting 99459 in addition to office/outpatient E/M codes, here’s what you should do:

• Review and update templates and billing protocols to reflect the changes effective June 1.
• Ensure your coding team is aware that 99459 is no longer separately payable when performed during an office/outpatient E/M for a patient covered by Cigna.

If you (or your staff) have questions regarding this change, please contact Cigna at 800-244-6224 or via live chat.

AAFP advocacy

The American Academy of Family Physicians (AAFP) supports payment policies that fairly pay physicians for the full scope of care they deliver. CPT code 99459 is a practice-expense code designed to capture the clinical staff time and supplies that aren’t already accounted for with the E/M service. The AAFP will continue to advocate for clarity and equity in payer policies that affect primary care.

— Brennan Cantrell, AAFP Senior Strategist, Market Transformation

Posted on June 5, 2025