Diagnostic and Therapeutic Colonoscopy (L34213) - R16 - Effective November 6, 2025

Date Posted: February 13, 2026

This Local Coverage Determination (LCD) has been revised under contractor numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

Effective Date: November 6, 2025

Summary of Changes: Under Coverage Indications, Limitations and/or Medical Necessity, removed the broken link to the Internet Only Manual (IOM).

Visit the Noridian Active LCDs webpage to view the Active LCD or access it via the CMS MCD.

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