CMS Retired NCD 220.6.15 for FDG PET Cancer Coverage — What Billing Teams Need to Know in 2026

TL;DR: The Centers for Medicare & Medicaid Services retired NCD 296 section 220.6.15 governing FDG PET scan coverage for unspecified cancer indications, replacing it with section 220.6.17. The retirement was formalized in a March 2023 revision, and this policy record was modified in the CMS system on January 9, 2026. Here's what your billing team needs to understand.

If you've been referencing NCD 296 section 220.6.15 for FDG PET billing on cancer cases that don't fall under a previously specified indication, stop. That section no longer exists in the NCD Manual. CMS replaced it with section 220.6.17, effective April 3, 2009 — but the formal retirement notice came much later, with the revision issued March 9, 2023. The January 9, 2026 modification reflects CMS's ongoing maintenance of the NCD 296 Medicare record. If your team hasn't updated its internal reference documents to point to 220.6.17, this is your cue to fix that now.

Quick-Reference Table

CMS FDG PET Cancer Coverage Criteria and Medical Necessity Requirements 2026

Section 220.6.15 of the NCD Manual is gone. If your chargemaster, coverage policy cheat sheets, or payer reference guides still cite it, those documents are pointing to a dead end.

The active CMS FDG PET coverage policy for cancer indications not previously specified now lives in section 220.6.17. That's where CMS documents medical necessity criteria, coverage conditions, and any prior authorization or documentation requirements for these cases. Your billing team should pull 220.6.17 directly from the CMS NCD Manual and treat it as the governing source.

CMS also directs billing teams to the broader PET Scans NCD at section 220.6 (NCD for PET Scans). That parent NCD covers the full range of FDG PET indications under Medicare. If you're billing FDG PET for any cancer-related indication — whether it's a diagnosis with an established coverage pathway or one that falls into the "all other" bucket — your medical necessity documentation and claim submission should align with what 220.6 and 220.6.17 specify, not 220.6.15.

The real issue here is that CMS retired 220.6.15 in 2009 but kept the section visible in the NCD Manual until the March 2023 revision formally removed it. Fifteen years is a long time for a retired section to sit in the manual. Some older internal billing guides or payer policy databases may still reference it. Check yours.

Coverage Indications at a Glance

This table reflects the retirement status of NCD 220.6.15 and where current coverage authority sits. The policy does not list specific CPT or HCPCS codes in this record.

CMS FDG PET Billing Guidelines and Action Items 2026

The administrative retirement of 220.6.15 and the January 9, 2026 system modification don't change what's clinically covered. They do create real claim denial risk if your team is working from outdated references. Here's what to do.

If you're unsure how this transition from 220.6.15 to 220.6.17 applies to your specific patient mix or specialty, loop in your compliance officer before your next audit cycle.

CPT, HCPCS, and ICD-10 Codes for FDG PET Under NCD 296

A Note on Codes in This Record

This policy record for NCD 296 (section 220.6.15, retired) does not list specific CPT or HCPCS codes. CMS did not include code-level data in this section of the NCD Manual.

For applicable FDG PET billing codes — including the HCPCS codes used to bill PET scans under Medicare — you need to reference two sources:

• NCD 220.6.17 (the active replacement section)
• NCD 220.6 — PET Scans (the parent NCD, cross-referenced by CMS in this record)

Those sources contain the current FDG PET coverage criteria, applicable HCPCS codes, and any code-level billing guidelines your team needs for clean claim submission.

Do not attempt to substitute codes from other PET-related policies into this retired section. Bill against the active NCD.

Why This Retirement Matters More Than It Looks

Here's the honest take: the substance of this change is minimal if your team has been billing correctly since 2009. The coverage moved to 220.6.17 sixteen years ago. But policy maintenance changes like this January 9, 2026 modification surface retired sections in payer policy databases and billing tools — which means they catch the attention of billing managers who wonder whether something just changed.

Nothing substantively changed in what CMS covers for FDG PET on January 9, 2026. What CMS did was clean up the NCD Manual record and make the retirement of 220.6.15 more visible in their system. The real risk is that billing teams see "Modified" on NCD 296 and assume the change is prospective. It isn't. The effective date of the retirement was April 10, 2023, and the underlying coverage shift happened in April 2009.

The practical takeaway: this is a documentation and reference hygiene issue, not a coverage change. But documentation problems cause claim denial, and claim denial costs real money. Treat it accordingly.