CMS Retired NCD 299 for FDG PET in Colorectal Cancer — What Billing Teams Need to Know in 2026
TL;DR: The Centers for Medicare & Medicaid Services retired NCD 299 (§220.6.4), the standalone coverage policy for FDG PET in colorectal cancer, effective April 10, 2023. It has been replaced by §220.6.17, the consolidated PET Scans NCD (§220.6). Billing teams who haven't updated their policy references are working from a dead document.
This change was formally documented in the NCD Manual revision issued March 9, 2023, with an effective date of April 10, 2023. The January 9, 2026 update simply confirms the retired status in CMS's policy database. If your team still references NCD 299 for FDG PET colorectal cancer billing, redirect all lookups to §220.6.17 immediately.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS (Centers for Medicare & Medicaid Services) |
| Policy | FDG PET for Colorectal Cancer — RETIRED (Replaced by §220.6.17) |
| Policy Code | NCD 299 |
| Change Type | Modified (Retirement Confirmed) |
| Effective Date | April 10, 2023 (confirmed in database January 9, 2026) |
| Impact Level | Medium — affects any team still referencing NCD 299 directly |
| Specialties Affected | Oncology, Gastroenterology, Radiology, Nuclear Medicine, General Surgery |
| Key Action | Update all internal policy references from NCD 299 / §220.6.4 to §220.6.17 |
CMS FDG PET Colorectal Cancer Coverage Criteria and Medical Necessity Requirements 2026
Here's the short version: §220.6.4 is gone. CMS removed it from the NCD Manual and folded colorectal cancer FDG PET coverage into the broader PET Scans NCD under §220.6.17. This happened in April 2023 — but the January 9, 2026 database entry is the signal that teams doing policy audits right now will flag.
The real issue is that many billing departments built their coverage policy workflows around specific NCD section numbers. If your charge capture documentation, pre-authorization checklists, or claim denial appeal templates still cite §220.6.4 or NCD 299, those references are now pointing at a retired section. That's a problem when payers or auditors ask you to cite the governing policy.
For FDG PET colorectal cancer billing, medical necessity criteria now live exclusively in §220.6.17. Pull that section. Read it. Update your references. The clinical indications for coverage haven't disappeared — they've moved.
Prior authorization requirements for FDG PET in colorectal cancer patients follow whatever §220.6.17 specifies, not NCD 299. If your team is citing the old section to justify prior auth decisions or to appeal a claim denial, you're on shaky ground. Medicare Administrative Contractors use the current NCD Manual, not legacy sections.
Whether FDG PET imaging is covered under Medicare for colorectal cancer patients is still a live question — it's just answered in a different place now. FDG PET colorectal cancer reimbursement continues under the framework CMS established in §220.6.17. The coverage policy itself did not disappear; the address changed.
Coverage Indications at a Glance
The policy data for NCD 299 contains no specific indication-level criteria — because the section has been retired. All indication-specific coverage status for FDG PET in colorectal cancer now lives in §220.6.17. The table below reflects what NCD 299 itself currently contains.
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| FDG PET for Colorectal Cancer | Retired — see §220.6.17 | See §220.6.17 | NCD 299 / §220.6.4 removed from NCD Manual effective April 10, 2023 |
| All FDG PET indications | Governed by §220.6.17 | See §220.6 (PET Scans NCD) | Cross-reference required for all claims and medical necessity determinations |
Do not rely on this table for claim-level coverage decisions. Go directly to §220.6.17.
CMS FDG PET Colorectal Cancer Billing Guidelines and Action Items 2026
This is a housekeeping change — but housekeeping errors cause real claim denials. Here's what to do.
| # | Action Item |
|---|---|
| 1 | Update every internal policy reference from §220.6.4 or NCD 299 to §220.6.17. This includes charge capture tools, billing guidelines documents, payer policy binders, and any EHR or billing system fields where NCD section numbers are stored. Do this before your next FDG PET colorectal cancer claim goes out. |
| 2 | Pull §220.6.17 from the CMS Medicare Coverage Database and review the current medical necessity criteria. Don't assume the criteria are identical to what §220.6.4 said. Confirm the indications, coverage limitations, and any documentation requirements. Your clinical team needs to know what currently supports medical necessity under the active section. |
| 3 | Update appeal templates that cite NCD 299. If you're fighting a claim denial for FDG PET in a colorectal cancer patient and your appeal letter cites §220.6.4 or NCD 299, update it. An appeal citing a retired NCD section looks sloppy at best and uninformed at worst. Cite §220.6.17. |
| 4 | Check your prior authorization workflows. If your prior auth checklists reference NCD 299 to justify FDG PET coverage for colorectal cancer patients, update those references. Medicare Administrative Contractors and their prior auth processes track the current NCD Manual. |
| 5 | Audit claims submitted in 2023 and 2024 that cited §220.6.4. The effective date of the retirement was April 10, 2023. If your team submitted claims after that date citing the old section, review whether any denials or audits could be traced to the stale reference. Talk to your compliance officer if you find a pattern. |
| 6 | If your team cross-references local coverage determinations alongside this NCD, verify your MAC's LCDs align with §220.6.17. Some MACs issued their own LCDs for PET imaging. The NCD change doesn't automatically update those. Check for consistency. |
| 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 Colorectal Cancer Under NCD 299
NCD 299 / §220.6.4 does not list any specific CPT, HCPCS, or ICD-10 codes in its current retired state. The policy data contains no codes.
Why No Codes Are Listed Here
This isn't an omission on our part. The retired section intentionally contains no code-level detail — all code-specific billing guidelines for FDG PET imaging, including colorectal cancer indications, are now housed in §220.6.17 (the PET Scans NCD, §220.6).
Where to Find the Applicable Codes
Go to the CMS Medicare Coverage Database and pull §220.6.17 directly. That section contains the governing codes and coverage criteria for FDG PET colorectal cancer billing. The cross-reference in NCD 299 points you there explicitly.
For FDG PET colorectal cancer billing, the relevant codes are whatever §220.6.17 specifies. Do not use NCD 299 as a code source. It has none.
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