CMS Retires NCD 220.6.5 for FDG PET in Lymphoma — What Billing Teams Need to Know

CMS has officially retired NCD section 220.6.5, which previously governed Medicare coverage of FDG-PET scanning for lymphoma, replacing it with section 220.6.17. This change under Policy Code NCD 300 (policy key 300-v3) is administrative in nature but carries real implications for billing teams that reference the NCD Manual for lymphoma PET claims. If your documentation, internal policies, or payer correspondence still cite §220.6.5, it's time to update your records.

What Changed: CMS NCD 220.6.5 FDG PET Lymphoma Coverage Is Now Retired

The Centers for Medicare & Medicaid Services formally removed section 220.6.5 from the NCD Manual. The retirement was issued on March 9, 2023, with an effective and implementation date of April 10, 2023—though the policy record itself has been updated with a processing date of March 12, 2026.

This isn't a new coverage restriction or an expansion. The underlying clinical coverage for FDG-PET in lymphoma didn't disappear—it migrated. Section 220.6.17 has been the authoritative home for this policy since April 3, 2009. The retirement of §220.6.5 is CMS formally closing the book on a legacy section that should not have been in active use for well over a decade.

For billing teams, that's the risk: if anyone on your staff—or any vendor, clearinghouse, or payer correspondence—is still citing §220.6.5, they are referencing a section that no longer exists in the NCD Manual. That creates compliance exposure and potential claim confusion.

Understanding the NCD Structure: Section 220.6 and FDG-PET Coverage

CMS organizes PET scan coverage under the broader NCD §220.6. Within that section, multiple subsections address specific clinical indications—oncology staging, restaging, monitoring treatment response, and more. FDG (fluorodeoxyglucose) PET is the radiotracer-based imaging modality most commonly used across these oncology indications.

Lymphoma is one of the better-supported FDG-PET indications under Medicare, given the clinical literature supporting its use in staging, restaging, and treatment response assessment for Hodgkin lymphoma and non-Hodgkin lymphoma subtypes. That coverage framework now lives entirely within §220.6.17.

If you need the specific coverage criteria, prior authorization requirements, or medical necessity language that governs FDG-PET for lymphoma under Medicare, §220.6.17 is the section to reference. CMS's NCD manual cross-reference within the retired policy points directly to the PET Scans NCD (§220.6) as the governing document.

Benefit Category: Diagnostic Tests (Other)

CMS classifies FDG-PET for lymphoma under the "Diagnostic Tests (other)" benefit category. This classification matters for billing because it affects how claims are processed and which Medicare benefit rules apply.

CMS notes explicitly that this may not be an exhaustive list of all applicable Medicare benefit categories for this item or service. Billing teams should confirm that the benefit category assignment aligns with the specific claim context before submission.

Affected Codes

This policy does not list specific CPT, HCPCS, or ICD-10 codes. The policy record contains no applicable codes in the data provided by CMS for this retired section. For the specific codes applicable to FDG-PET for lymphoma under Medicare, billing teams should refer directly to NCD §220.6.17 and the broader PET Scans NCD (§220.6), where current covered codes and applicable diagnosis codes are documented.

Important: Do not continue using code lists or claim edits tied to §220.6.5 as a standalone reference. Any code-level guidance for this indication now flows from §220.6.17.

Why This Retirement Matters for Revenue Cycle Teams

Administrative retirements like this one tend to get underestimated. Here's why this one deserves attention:

Denial risk from stale documentation. If your medical necessity templates, ABN workflows, or internal coverage policies reference §220.6.5, a payer auditor or Medicare contractor could flag that your documentation cites a retired, non-existent section. That's an avoidable compliance issue.

Vendor and clearinghouse alignment. Revenue cycle software, payer policy libraries, and clearinghouse edits sometimes lag behind CMS updates. If your system still flags §220.6.5 as a valid cross-reference, it needs to be corrected to §220.6.17.

Teaching and training materials. Oncology billing training materials, coder reference sheets, and denial management playbooks that mention the old section number should be updated. This is particularly important in practices that bill high volumes of PET imaging for hematology-oncology.

What Your Billing Team Should Do