Effective June 1, 2025, Cigna has announced a significant policy change for CPT code 99459 related to pelvic examinations. This update impacts billing practices and requires immediate attention from healthcare providers and RCM teams.
Key Points:
- Effective Date: June 1, 2025
- Policy Change: Cigna will administratively deny CPT 99459 for pelvic exams when billed as incidental to standard E&M codes (99202–99205, 99212–99215).
- Exceptions: CPT 99459 will still be reimbursed when billed with preventive E&M codes.
Action Required:
- Ensure CPT 99459 is only billed with preventive E&M codes to avoid denials.
- For dates of service on or after June 1, 2025, Cigna will not separately reimburse CPT 99459 with standard E&M codes, as it will be considered part of the E&M service.
Why This Matters:
This policy change aims to streamline billing practices and reduce administrative denials. Practice managers and healthcare providers must update their billing processes to comply with Cigna’s new guidelines.