TL;DR: The Centers for Medicare & Medicaid Services retired NCD 220.6.5 (FDG PET for Lymphoma) and replaced it with section 220.6.17. If your team still references 220.6.5 in your billing guidelines or payer policy library, update it now — the old section is gone.
CMS formally retired NCD 220.6.5 from the National Coverage Determination Manual, effective April 10, 2023, with the revision published January 9, 2026 in the NCD 300 CMS system. The active FDG-PET lymphoma coverage policy now lives entirely under section 220.6.17. The policy does not list specific CPT or HCPCS codes in the retired section itself — those are governed by the replacement section 220.6.17 and the parent PET scan NCD at §220.6.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS |
| Policy | FDG PET for Lymphoma (RETIRED) — Replaced by NCD 220.6.17 |
| Policy Code | NCD 300 (section 220.6.5) |
| Change Type | Modified (retirement/redirect) |
| Effective Date | April 10, 2023 (retirement); revision published January 9, 2026 |
| Impact Level | Medium — administrative risk if teams still cite the retired section |
| Specialties Affected | Oncology, Nuclear Medicine, Radiology, Hematology |
| Key Action | Update all internal billing guidelines and payer policy references from NCD 220.6.5 to NCD 220.6.17 immediately |
CMS FDG PET Lymphoma Coverage Criteria and Medical Necessity Requirements 2026
Here's the real situation: CMS retired section 220.6.5 governing FDG PET for lymphoma back on April 10, 2023. The January 9, 2026 revision simply confirms that removal and cross-references the replacement.
The active CMS FDG PET lymphoma coverage policy is now section 220.6.17. That is where you find current medical necessity criteria, coverage indications, and billing guidelines for FDG-PET in lymphoma patients. If your team is still pulling up 220.6.5 to answer a prior authorization question or respond to a claim denial, you are working from a dead document.
The parent NCD at §220.6 governs PET scans broadly for Medicare. Section 220.6.17 is the lymphoma-specific child policy. Both are active. Section 220.6.5 is not.
The retired section itself contains no medical necessity criteria, no coverage indications, and no applicable codes. It exists in the NCD Manual only as a tombstone — a notice that the content moved. Any medical necessity determination for FDG PET in lymphoma billing must reference 220.6.17, not 220.6.5.
Coverage Indications at a Glance
Because section 220.6.5 is retired and contains no substantive coverage criteria, the table below reflects what this policy does and does not address. For full indication-level coverage details, you must reference NCD 220.6.17 directly.
| Indication | Status Under 220.6.5 | Relevant Codes | Notes |
|---|---|---|---|
| FDG PET for Lymphoma (all indications) | Retired — no active coverage status | See NCD 220.6.17 | Coverage policy relocated to section 220.6.17, effective April 3, 2009 |
| Any lymphoma-related PET billing | Not governed here | See §220.6 (parent NCD) | Bill under active policy section only |
The policy does not list specific CPT or HCPCS codes in this retired section. Do not use 220.6.5 as a billing authority for any claim.
CMS FDG PET Lymphoma Billing Guidelines and Action Items 2026
This retirement is not a new development clinically — coverage criteria did not change. The risk is entirely administrative. Billing teams that reference outdated policy sections in their documentation, prior authorization requests, or appeal letters create unnecessary exposure.
Here is what to do:
| # | Action Item |
|---|---|
| 1 | Audit your internal policy library today. Search your billing guidelines, payer policy binders, and any internal reference documents for "220.6.5" or "NCD 220.6.5." Replace every instance with a reference to NCD 220.6.17. |
| 2 | Update your prior authorization templates. If your team submits prior auth requests for FDG PET in lymphoma patients and cites a specific NCD section, confirm the citation reads 220.6.17 — not 220.6.5. Citing a retired section in a prior auth request is a simple fix that can become a costly delay if a reviewer flags it. |
| 3 | Check your appeal letter templates. Claim denial appeals that cite NCD 220.6.5 as the coverage authority are citing a section CMS removed. Update those templates to reference 220.6.17 and §220.6. |
| 4 | Brief your billing team on the distinction between the retired and active sections. The effective date of the retirement was April 10, 2023 — but the January 9, 2026 revision confirms the section's removal. Anyone who hasn't updated their references has a two-year-old error in their workflow. |
| 5 | Pull the full NCD 220.6.17 policy and review it against your current charge capture. The Centers for Medicare & Medicaid Services moved the substantive FDG PET lymphoma coverage criteria to 220.6.17 in 2009. If your team hasn't reviewed that section recently, now is the time. Reimbursement for FDG PET in lymphoma billing depends on meeting the criteria in the active section. |
| 6 | Contact your Medicare Administrative Contractor if you have open claims or appeals citing 220.6.5. If any pending claim or appeal references the retired section, correct it before the MAC touches it. Your MAC can clarify whether a resubmission is needed. |
If your organization has a high volume of oncology PET billing and you're not sure which section your templates reference, loop in your compliance officer before submitting another batch.
| 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 Lymphoma Under NCD 300
The retired section 220.6.5 does not list any CPT, HCPCS, or ICD-10 codes. CMS explicitly removed all substantive content from this section when it was retired.
No Codes Listed in This Policy Section
| Code | Type | Description |
|---|---|---|
| — | — | No codes specified in NCD 220.6.5 (retired). See NCD 220.6.17 for applicable codes. |
The FDG PET lymphoma billing codes — including the relevant PET scan HCPCS codes — are governed by NCD 220.6.17 and the parent PET scan NCD at §220.6. Do not reference this retired section as a coding authority.
Why This Matters More Than It Looks
A retired policy section sounds like housekeeping. In most cases, it is. But FDG PET for lymphoma billing has real financial exposure — PET scans are high-cost procedures, and claim denials based on incorrect policy citations are avoidable.
The gap between when CMS retired 220.6.5 (April 2009, formalized in April 2023) and today means some teams have been working with outdated references for years without a denial to trigger a correction. This January 2026 revision is your prompt to fix it.
The real issue here is not coverage — medical necessity criteria for FDG PET in lymphoma did not change with this retirement. The issue is documentation integrity. When your prior auth, your appeal letter, and your billing guidelines all cite a section that no longer exists, you are one sharp-eyed reviewer away from a delay or denial that has nothing to do with whether the scan was clinically appropriate.
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