TL;DR: The Centers for Medicare & Medicaid Services modified NCD 301, the FDG PET for Lung Cancer coverage policy, effective January 9, 2026. Section 220.6.2 is retired — billing teams should point all clinical documentation and coverage questions to its replacement, NCD section 220.6.17.
CMS retired NCD 301 (section 220.6.2) covering FDG PET imaging for lung cancer and replaced it with section 220.6.17. This isn't a subtle tweak to medical necessity criteria. The old section is gone from the NCD Manual entirely. If your billing team or clinical staff still references 220.6.2 for coverage guidance, they're working from a dead policy.
The effective date of April 3, 2009 tells you this consolidation happened years ago. But the January 9, 2026 update to NCD 301 in the Medicare Coverage Database makes this the active administrative record. Your documentation workflows, payer communication templates, and internal billing guidelines should reflect 220.6.17 — not 220.6.2.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS |
| Policy | FDG PET for Lung Cancer (Replaced with Section 220.6.17) — RETIRED |
| Policy Code | NCD 301 |
| Change Type | Modified |
| Effective Date | 2026-01-09 (administrative); original retirement effective April 3, 2009 |
| Impact Level | Medium — affects documentation references and internal SOPs |
| Specialties Affected | Oncology, Pulmonology, Radiology, Nuclear Medicine |
| Key Action | Update all internal references from NCD 220.6.2 to NCD 220.6.17 immediately |
CMS FDG PET for Lung Cancer Coverage Criteria and Medical Necessity Requirements 2026
The CMS FDG PET lung cancer coverage policy now lives entirely under section 220.6.17 of the NCD Manual. Section 220.6.2 — the original NCD — has been removed.
This matters for medical necessity determinations. If your team cites section 220.6.2 in a prior authorization request or in an appeal letter, Medicare reviewers are working from 220.6.17. A citation mismatch won't automatically cause a claim denial, but it signals sloppy documentation. That's the last thing you want when you're defending a PET scan for a lung cancer staging workup.
The cross-reference in NCD 301 points billing teams directly to the broader PET Scans NCD at section 220.6. That umbrella NCD now governs FDG PET reimbursement across oncology indications, including lung cancer. Your coverage policy lookups should start there.
Prior authorization requirements for FDG PET in lung cancer aren't addressed within NCD 301 itself — those are handled at the Medicare Administrative Contractor (MAC) level. Check your MAC's local coverage determination (LCD) for any prior auth triggers specific to your region. Don't assume national NCD coverage automatically flows through without a prior authorization requirement in your jurisdiction.
Medical necessity for FDG PET in lung cancer — staging, restaging, and treatment monitoring — is defined in 220.6.17. Pull that section. Make sure your clinical documentation templates match the criteria there, not the retired language from 220.6.2.
Coverage Indications at a Glance
The policy data for NCD 301 (section 220.6.2) does not list specific indication-level criteria. Those criteria moved to section 220.6.17 when CMS retired 220.6.2. The table below reflects what NCD 301 tells us about coverage status as of January 9, 2026.
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| FDG PET for Lung Cancer (all indications) | Refer to NCD 220.6.17 | Not specified in NCD 301 | Section 220.6.2 retired; all coverage determinations governed by 220.6.17 |
| General PET Scan Coverage | Refer to NCD 220.6 (§220.6) | Not specified in NCD 301 | Cross-reference to umbrella PET Scans NCD |
If you need the active indication-by-indication breakdown — staging vs. restaging vs. treatment response, for example — pull section 220.6.17 directly from the Medicare Coverage Database. That's where the live medical necessity criteria sit.
CMS FDG PET Lung Cancer Billing Guidelines and Action Items 2026
Here's what your billing team needs to do now.
| # | Action Item |
|---|---|
| 1 | Replace all internal references to NCD 220.6.2 with NCD 220.6.17. Check your charge capture tools, payer communication templates, appeal letter boilerplate, and any SOPs that cite NCD section numbers. Do this before your next FDG PET claim goes out. |
| 2 | Pull and review section 220.6.17 in full. The retired section 220.6.2 contained coverage criteria your team may have memorized. The replacement section 220.6.17 is the governing document now. Review it with your medical director or billing consultant to confirm your documentation workflows still align. |
| 3 | Audit recent FDG PET claims for lung cancer. Check any claims filed in the past 90 days that reference NCD 220.6.2. If you've cited the retired section in documentation or appeals, note those cases. They may need corrective documentation if they're still open. |
| 4 | Check your MAC's LCD for prior authorization requirements. NCD 220.6.17 sets the national floor for coverage policy. Your local Medicare Administrative Contractor may impose additional prior auth steps or documentation requirements. If you're billing in a region with active LCD coverage policies for PET imaging, confirm those are still current. |
| 5 | Update your denial management workflow. If you receive a claim denial citing NCD coverage policy issues for FDG PET lung cancer billing, your appeal should reference 220.6.17 — not 220.6.2. A denial that cites the wrong section is harder to appeal cleanly. Make sure your denial response templates reflect the correct NCD. |
| 6 | Verify your billing software vendor has updated NCD references. Some clearinghouses and billing platforms cache NCD citations. Confirm your vendor reflects the January 9, 2026 update to NCD 301. If they're still pointing to 220.6.2, flag it with your account rep. |
If you're unsure how this transition affects your specific payer mix or documentation templates, talk to your compliance officer before the next billing cycle. The clinical criteria didn't change — but the administrative home for those criteria did, and sloppy cross-references create audit risk.
| 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 Lung Cancer Under NCD 301
NCD 301 does not list specific CPT or HCPCS codes. The policy document contains no code-level data.
This is worth flagging clearly. The absence of codes in NCD 301 is by design — the section was retired and replaced. All code-level billing guidelines for FDG PET lung cancer are now governed by NCD 220.6.17 and the umbrella PET Scans NCD at section 220.6.
Where to Find the Active Codes
Go to the Medicare Coverage Database entry for section 220.6.17 directly. That's where CMS publishes the applicable HCPCS codes for FDG PET imaging under Medicare. Do not use NCD 301 as your code reference — it will not give you what you need.
For FDG PET lung cancer billing, the relevant HCPCS codes historically have sat within the PET scan code family. But pull those from 220.6.17, not from memory or from this retired NCD. CMS updates code tables when policy sections change, and you want the current list.
If your billing team needs a verified code reference for FDG PET reimbursement under Medicare, that lookup belongs in 220.6.17 — and your PayerPolicy account will surface any future changes to that section automatically.
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