Medicare local coverage
Medicare coverage for Transanal Endoscopic Surgery (TES) (LCD)
One Medicare Administrative Contractor, Palmetto GBA, publishes a local coverage determination (LCD) for Transanal Endoscopic Surgery (TES). The snapshot lists 1 LCD record: 1 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 |
|---|---|---|---|
Palmetto GBAMAC - Part A, MAC - Part B | L38551 | Active | Dec 13, 2024 |
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.
- A58000Palmetto GBAUpdated Aug 18, 2020
CMS also lists 1 response-to-comments article for this topic, where contractors answer public comments on the proposed LCD: A58300.
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
- Blepharoplasty, Eyelid Surgery, and Brow Lift
- Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy
- Cataract Extraction (including Complex Cataract Surgery)
- Cataract Surgery
- Cataract Surgery in Adults
- Cosmetic and Reconstructive Surgery
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.