D01.3 coverage policies: Medicare and commercial payers

56 active Medicare policies list D01.3, and 1 commercial payer policy lists it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.

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Medicare policies listing D01.3

LCD · PALMETTO-JJ-L33457

Cardiac Radionuclide Imaging

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33457

Cardiac Radionuclide Imaging

JM · Effective Oct 1, 2015

LCD · WPS-J5-L34614

Colonoscopy and Sigmoidoscopy-Diagnostic

J5 · Effective Oct 1, 2015

LCD · WPS-J8-L34614

Colonoscopy and Sigmoidoscopy-Diagnostic

J8 · Effective Oct 1, 2015

LCD · CGS-J15-L34005

Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J15 · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L34454

Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L34454

Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

JM · Effective Oct 1, 2015

LCD · PALMETTO-JJ-L33459

Computerized Axial Tomography (CT), Thorax

JJ · Effective Oct 1, 2015

LCD · PALMETTO-JM-L33459

Computerized Axial Tomography (CT), Thorax

JM · Effective Oct 1, 2015

LCD · NORIDIAN-JE-L34213

Diagnostic and Therapeutic Colonoscopy

Commercial payer policies listing D01.3

1 policy from 1 payer

Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.

Anthem

Anthem policies listing D01.3, with the code’s status in each
Policy	Effective	Status of D01.3
Transrectal UltrasonographyClinical Guideline · ANTHEM-CG-RAD-28	Apr 15, 2026	Covered