TL;DR: The Centers for Medicare & Medicaid Services retired NCD 220.6.14 — the FDG PET coverage policy for brain, cervical, ovarian, pancreatic, small cell lung, and testicular cancers — and replaced it with section 220.6.17, with the retirement recorded under NCD 295 as of January 9, 2026. Here's what billing teams need to know.
If your team still routes FDG PET claims for these cancer types through old documentation referencing section 220.6.14, you have a claim denial problem waiting to happen. The Centers for Medicare & Medicaid Services formally retired that section years ago — the replacement with 220.6.17 was effective April 3, 2009 — but the retirement was officially documented in the NCD Manual on March 9, 2023, with implementation on April 10, 2023. The January 9, 2026 update to NCD 295 reflects the current standing of this policy. This policy does not list specific CPT or HCPCS codes in its retired form — billing guidelines now live entirely under the active replacement section.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS |
| Policy | FDG PET for Brain, Cervical, Ovarian, Pancreatic, Small Cell Lung, and Testicular Cancers — RETIRED (Replaced by §220.6.17) |
| Policy Code | NCD 295 |
| Change Type | Modified (Retirement documented) |
| Effective Date | 2026-01-09 (retirement originally effective April 10, 2023) |
| Impact Level | Medium — low operational lift if your team already updated to §220.6.17, high if you haven't |
| Specialties Affected | Oncology, Nuclear Medicine, Radiology, Radiation Oncology |
| Key Action | Confirm all FDG PET billing for these six cancer types references §220.6.17, not §220.6.14 |
CMS FDG PET Coverage Criteria and Medical Necessity Requirements 2026
The CMS FDG PET coverage policy for brain, cervical, ovarian, pancreatic, small cell lung, and testicular cancers no longer lives in section 220.6.14. It hasn't since April 3, 2009. The active coverage policy and all medical necessity criteria are in section 220.6.17 of the NCD Manual, cross-referenced under the parent PET Scans NCD at §220.6.
This matters because medical necessity documentation tied to the wrong NCD section creates audit exposure. If your clinical staff is pulling reference material from old payer portals or internal policy libraries that still cite §220.6.14, that documentation is referencing a retired policy. It won't match what a Medicare Administrative Contractor auditor expects to see.
The good news: the underlying coverage policy for FDG PET in these cancer types didn't disappear. It consolidated. Section 220.6.17 carries the coverage rules forward. Your job is confirming your team points to the right section.
Prior authorization requirements for FDG PET under Medicare depend on the specific indication and setting — they're addressed in the active §220.6.17 language and applicable local coverage determinations from your MAC. If your MAC has issued an LCD layered on top of the NCD, those LCD terms govern your documentation and prior auth requirements at the regional level.
Coverage Indications at a Glance
The retired section §220.6.14 does not carry active coverage indications — those are now governed by §220.6.17. This table reflects the retirement status of the old section and where to find current guidance.
| Indication | Status Under §220.6.14 | Current Governing Section | Notes |
|---|---|---|---|
| Brain cancer — FDG PET | Retired | §220.6.17 | All medical necessity criteria now in replacement section |
| Cervical cancer — FDG PET | Retired | §220.6.17 | All medical necessity criteria now in replacement section |
| Ovarian cancer — FDG PET | Retired | §220.6.17 | All medical necessity criteria now in replacement section |
| Pancreatic cancer — FDG PET | Retired | §220.6.17 | All medical necessity criteria now in replacement section |
| Small cell lung cancer — FDG PET | Retired | §220.6.17 | All medical necessity criteria now in replacement section |
| Testicular cancer — FDG PET | Retired | §220.6.17 | All medical necessity criteria now in replacement section |
If you're billing FDG PET for any of these cancer types and your reimbursement claims reference §220.6.14, update your internal documentation now. Any reference to the retired section is a documentation gap — not a catastrophic one, but a gap that can slow down claims or invite additional scrutiny.
CMS FDG PET Billing Guidelines and Action Items 2026
| # | Action Item |
|---|---|
| 1 | Audit your internal policy library before the next billing cycle. Search for any documents, charge capture templates, or superbills that reference NCD §220.6.14. Replace every instance with a reference to §220.6.17. This is the single highest-value action item from this update. |
| 2 | Pull the active §220.6.17 NCD and review it against your current FDG PET billing practices. The retirement of §220.6.14 means your team should be working from the replacement section already — but confirm it. Check the CMS Medicare Coverage Database directly for the current language. |
| 3 | Check your MAC's local coverage determination for FDG PET. NCDs set the floor; LCDs set the regional ceiling. Your Medicare Administrative Contractor may have issued additional documentation requirements or prior authorization rules layered on top of the NCD. If you're unsure which MAC serves your region, look it up on the CMS website before your next FDG PET claim goes out. |
| 4 | Review your FDG PET billing for any claims currently in process. If any pending claims reference §220.6.14 in supporting documentation, flag them now. A claim referencing a retired NCD section isn't automatically denied, but it's an unnecessary risk. Correct the documentation before the claim finalizes. |
| 5 | Train your coding and clinical documentation teams on the section change. The effective date of the retirement at the policy level was April 10, 2023. The January 9, 2026 update to NCD 295 confirms this retirement is permanent. Any coder or physician still pulling from §220.6.14 for FDG PET billing guidelines needs a correction today. |
| 6 | If your team bills FDG PET across multiple cancer types simultaneously, loop in your compliance officer. The consolidated §220.6.17 covers a broader set of oncologic indications than §220.6.14 did. Your compliance officer should verify your documentation templates align with the current, active NCD language — especially if you're billing for any of the six cancer types listed in the retired section. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for FDG PET Under NCD 295
The retired NCD §220.6.14 does not list specific CPT or HCPCS codes. The policy document contains no applicable codes in its retired form.
Where to Find Active FDG PET Billing Codes
All active CPT, HCPCS, and ICD-10 codes governing FDG PET billing for brain, cervical, ovarian, pancreatic, small cell lung, and testicular cancers now fall under section §220.6.17 and the parent §220.6 NCD for PET Scans. Go to the CMS Medicare Coverage Database, pull the active NCD for PET Scans (§220.6), and reference §220.6.17 for the specific cancer types listed here.
Do not assume the codes listed in any third-party resource referencing the old §220.6.14 are complete or current. Pull directly from the source.
A Note on FDG PET Billing Without the Retired Section's Code List
The absence of a code list in the retired §220.6.14 is not unusual. Retired NCDs often carry no attached code tables — those migrate to the replacement section. For FDG PET billing, the practical implication is simple: your coding team should never need to reference §220.6.14 again. The code-level guidance lives in §220.6.17.
If you're uncertain how your current FDG PET charge capture aligns with the active NCD, that's the right question to bring to your billing consultant or compliance officer before your next claim submission.
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