CMS Retires NCD 220.6.14 for FDG PET Scans in Six Cancer Types — What Billing Teams Need to Know
CMS has formally retired NCD 220.6.14, the longstanding national coverage determination governing FDG-PET imaging for brain, cervical, ovarian, pancreatic, small cell lung, and testicular cancers under Policy Code NCD 295 (policy key 295-v3). This retirement is administrative in nature — the section has been replaced by NCD 220.6.17, which has governed FDG-PET coverage for these indications since April 3, 2009. If your billing team is still referencing 220.6.14 in any internal documentation, coding workflows, or payer correspondence, it's time to update those references now.
| Field | Detail |
|---|---|
| Payer | CMS (Centers for Medicare & Medicaid Services) |
| Policy | FDG PET for Brain, Cervical, Ovarian, Pancreatic, Small Cell Lung, and Testicular Cancers (NCD 220.6.14 — RETIRED) |
| Policy Code | NCD 295 |
| Change Type | Modified (Section retired; replaced by NCD 220.6.17) |
| Effective Date | 2026-03-12 |
| Impact Level | Low — coverage rules themselves have not changed; administrative retirement only |
| Specialties Affected | Oncology, Radiology, Nuclear Medicine, Radiation Oncology, Gynecologic Oncology, Pulmonology, Urology |
| Key Action | Update all internal policy references from NCD 220.6.14 to NCD 220.6.17 for FDG-PET coverage determinations in these six cancer types. |
What CMS Changed: NCD 220.6.14 Retirement and the Move to NCD 220.6.17
The Centers for Medicare & Medicaid Services issued revision 11892 to the NCD Manual on March 9, 2023, with an effective and implementation date of April 10, 2023. That revision officially removed section 220.6.14 from the NCD Manual entirely. The March 12, 2026 update in NCD 295 (policy key 295-v3) reflects the downstream administrative update to the broader PET scan NCD policy record.
The practical reality is that CMS had already replaced 220.6.14 with 220.6.17 back on April 3, 2009 — well over 15 years ago. What this retirement formalizes is the removal of the old section stub from the NCD Manual so it no longer appears as an active reference point. Coverage rules for FDG-PET in these six cancer types continue under NCD 220.6.17.
For billing teams and RCM directors, the immediate concern is documentation hygiene: any internal coverage checklists, LCD crosswalk documents, or denial appeal templates that cite 220.6.14 are now referencing a formally retired, non-existent section. That creates unnecessary audit exposure.
FDG-PET Coverage for Oncology: Where the Governing Rules Now Live
All FDG-PET coverage determinations for the six cancer indications that were previously housed under 220.6.14 — brain, cervical, ovarian, pancreatic, small cell lung, and testicular cancers — are now governed exclusively by NCD 220.6.17, which falls under the broader NCD §220.6 (PET Scans).
CMS's cross-reference within this retired policy points directly to the PET Scans NCD. Billing teams should bookmark the CMS Medicare Coverage Database entry for NCD §220.6 and ensure that NCD 220.6.17 is the active citation used in:
- Medical necessity documentation
- Prior authorization requests
- Denial appeal letters citing NCD authority
- Internal coding guidance and payer policy logs
If your practice management system or RCM platform has policy references hard-coded or stored in template language, this is a good moment to audit those fields. Appeals citing a retired NCD section can create unnecessary friction with Medicare Administrative Contractors (MACs), even when the clinical facts support coverage.
Which Cancer Types Are Affected by This Policy Record
To be explicit about scope, the six cancer indications that were covered under the now-retired 220.6.14 — and which continue to be covered under 220.6.17 — are:
- Brain cancers — FDG-PET in neurologic oncology workups
- Cervical cancer — gynecologic oncology applications
- Ovarian cancer — staging and restaging determinations
- Pancreatic cancer — a historically complex FDG-PET coverage area
- Small cell lung cancer — distinct from non-small cell lung cancer coverage rules
- Testicular cancer — urologic oncology indications
Each of these carries specific medical necessity criteria under 220.6.17. If your team is building coverage determination workflows for FDG-PET orders in any of these cancer types, verify against the active 220.6.17 language, not any legacy documentation derived from 220.6.14.
| 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 |
Affected Codes
The policy does not list specific CPT, HCPCS, or ICD-10 codes within this retired section. No codes are enumerated in NCD 295 (policy key 295-v3) as published. For applicable procedure codes associated with FDG-PET imaging, billing teams should refer directly to the active NCD §220.6 and NCD 220.6.17 in the CMS Medicare Coverage Database, where PET scan procedure codes and applicable diagnosis codes are maintained under the governing policy.
Do not rely on any code lists extracted from 220.6.14 documentation — that section has been removed from the NCD Manual and should no longer serve as a code reference source.
What Your Billing Team Should Do
| # | Action Item |
|---|---|
| 1 | Audit internal documentation within the next 30 days. Search your RCM platform, SharePoint, or shared drives for any documents referencing "220.6.14." Replace all instances with "NCD 220.6.17" and confirm the source document is the active CMS NCD Manual entry. |
| 2 | Update denial appeal templates immediately. Any appeal letter templates that cite NCD 220.6.14 as the coverage authority for FDG-PET in brain, cervical, ovarian, pancreatic, small cell lung, or testicular cancer must be updated before your next submission. MACs reviewing appeals can flag citations to retired sections — this is an avoidable complication. |
| 3 | Verify prior authorization language with your MAC. If your Medicare Administrative Contractor has any coverage or prior auth guidance that references 220.6.14 in its own documentation, reach out to confirm they are applying 220.6.17 criteria. MAC local coverage articles occasionally lag behind NCD Manual updates. |
| 4 | Confirm your payer policy tracking source is current. This retirement was effective April 10, 2023, but is appearing in policy records dated 2026 — a gap that illustrates how easy it is for outdated NCD references to persist in billing systems. Set a calendar reminder to re-verify your FDG-PET policy references quarterly. |
| 5 | Brief your oncology and radiology coding staff. Even if this change is administrative, coders who handle FDG-PET claims for these six cancer types should know that 220.6.14 is retired. One sentence in a team Slack channel or a quick email is enough — the goal is preventing a future coder from pulling a retired reference off a shared drive and treating it as current. |
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