Medicare local coverage
Medicare coverage for Colon Capsule Endoscopy (CCE) (LCD)
7 Medicare Administrative Contractors publish a local coverage determination (LCD) for Colon Capsule Endoscopy (CCE). The snapshot lists 7 LCD records: 7 active.
An LCD applies only in the jurisdiction of the contractor that wrote it. Two contractors can cover the same service with different criteria, documentation requirements and covered diagnoses, so check the LCD from the contractor that processes your claims.
LCDs by contractor
| Contractor | LCD | Status | Last updated |
|---|---|---|---|
CGS Administrators, LLCMAC - Part A, MAC - Part B | L38777 | Active | Dec 10, 2021 |
First Coast Service Options, Inc.MAC - Part A, MAC - Part B | L38805 | Active | Feb 5, 2021 |
Noridian Healthcare Solutions, LLCMAC - Part A, MAC - Part B | L38824 | Active | Sep 2, 2025 |
Novitas Solutions, Inc.MAC - Part A, MAC - Part B | L38807 | Active | Feb 5, 2021 |
Palmetto GBAMAC - Part A, MAC - Part B | L38755 | Active | Feb 17, 2021 |
Wellpoint FederalMAC - Part A, MAC - Part B | L38571 | Active | Jul 14, 2026 |
WPS Insurance CorporationMAC - Part A, MAC - Part B | L38837 | Active | May 20, 2025 |
An LCD marked Future has been finalized and is in its notice period; it applies from the effective date shown. LCD IDs link to the record on cms.gov.
Billing and coding articles
The codes live in the billing and coding article that goes with each LCD: the CPT and HCPCS codes the policy applies to, the ICD-10 codes that support medical necessity, and any modifier or documentation rules.
- A58294Wellpoint FederalUpdated Jul 14, 2026
- A58321Palmetto GBAUpdated Dec 21, 2021
- A58410First Coast Service Options, Inc.Updated Jan 14, 2022
- A58414Novitas Solutions, Inc.Updated Jan 14, 2022
- A58436Noridian Healthcare Solutions, LLCUpdated Sep 4, 2025
- A58471WPS Insurance CorporationUpdated Feb 15, 2023
CMS also lists 7 response-to-comments articles for this topic, where contractors answer public comments on the proposed LCD: A58596, A58598, A58618, A58630, A58944, A58947, A58959.
Check claim lines against Medicare coverage
Coverage Check tells you whether a claim's diagnoses support Medicare LCD or NCD coverage for each procedure line, and shows the policy and CMS source behind each answer.
Related LCD topics
- Endoscopy by Capsule
- Wireless Capsule Endoscopy
- Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy
- Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
- Upper Gastrointestinal Endoscopy and Visualization
All Medicare LCD topics · National coverage determinations · Payer policies by payer
Source: CMS Medicare Coverage Database, via the public CMS Coverage API, snapshot Oct 25, 2026. LCDs change between snapshots; confirm the version in effect for your date of service on cms.gov before billing.