Pelvic Exam Policy Update (Commercial Line of Business) – Effective July 1, 2026

Posted on September 30, 2026

Commercial Line of Business – Pelvic Exam Denial Policy Change

At Health New England, we continuously evaluate opportunities to improve the provider and member experience. Based on your feedback, we have made the decision to remove denials for CPT 99459 Pelvic exam services for our Commercial Line of Business.

Effective July 1, 2026, claims submitted for Pelvic exams will no longer be subject to denial under the policies listed below for Commercial members.

The following policies will be updated to reflect this change:

• PP032POL Preventive Services
• PP006POL Evaluation and Management Professional Services

We appreciate your partnership and the valuable feedback that helped guide this change.

Categories: Provider Newsletter