Wiki Medicare Screening Colonoscopy LCD's

[Vanessa Treadway]

Is there a current Medicare LCD for High Risk Screening Colonoscopies? When I try to pull the last know LCD for this, it states it expired in November 2022 but then instructs you to scroll to the bottom and click on another one for current list. That list is titled Superseded at top and has no expiration date so I'm understanding it as being the most current list of covered codes. However, when you pull LCD's for Colonoscopy/Flex Sig/Proctosig, it does have procedure code of G0105 (High Risk Colon) listed as a covered code in that document. But that document doesn't have dx codes Z08 and Z83.71_, so I'm confused. Does anyone have clarification on this? Thank you

 

[bethb]

Which MAC? I do not think there is a specific LCD (at least for Novitas / Pennsylvania) for a high-risk screening colonoscopy. The guidelines for what is considered "high risk" and screening frequencies are given in the Medicare Preventive Services Quick Reference chart. Link - MLN006559 – Medicare Preventive Services

Click Colorectal Cancer Screening - under Medicare Covers - there is a link to high colorectal cancer risk. This lists the high risk criteria from the Code of Federal Regulations.

The Medicare Preventive Services Quick Reference chart also lists screening frequencies for non-high risk and for high risk.

As always, make sure to double-check with your MAC for any additional guidelines, rules, etc.

I hope this helps