FDG PET for Thyroid Cancer (Replaced with Section 220.6.17) - RETIRED — NCD 302 | CMS Coverage Update

TL;DR: The Centers for Medicare & Medicaid Services modified NCD 302 on January 9, 2026, officially retiring section 220.6.11 on FDG PET for thyroid cancer and replacing it with section 220.6.17. If your team bills PET scans for thyroid cancer under Medicare, you need to know which section of the NCD Manual now governs your claims.

What CMS Changed in NCD 302 for FDG PET Thyroid Cancer Billing

The Centers for Medicare & Medicaid Services retired section 220.6.11 of the National Coverage Determination Manual. That section covered FDG PET for thyroid cancer. The replacement — section 220.6.17 — has been the operative section since April 3, 2009. This January 2026 update makes the retirement official in the NCD Manual.

Here's the real issue: the underlying coverage policy for FDG PET in thyroid cancer didn't change on January 9, 2026. What changed is the administrative record. CMS formally removed 220.6.11 from the Manual and added a cross-reference pointing to the active section. If your team has been billing correctly under 220.6.17, your reimbursement path doesn't change. If your documentation or payer correspondence still references 220.6.11, you have a problem.

This kind of housekeeping update trips up billing teams more than it should. Policy numbers and section references show up in prior authorization requests, internal charge capture guides, and payer dispute letters. A stale section reference can create unnecessary back-and-forth with a Medicare Administrative Contractor — even when the underlying coverage criteria haven't changed.

CMS FDG PET Thyroid Cancer Coverage Criteria and Medical Necessity Requirements 2026

NCD 302 sits within the broader NCD for PET Scans (§220.6). That parent policy is the governing document for medical necessity determinations on all FDG PET imaging under Medicare, including thyroid cancer indications.

Section 220.6.17 — the active replacement — now controls coverage criteria and medical necessity standards for FDG PET in thyroid cancer. CMS does not publish active clinical criteria under the retired 220.6.11. Your billing team must reference 220.6.17 when documenting medical necessity for any FDG PET claim tied to thyroid cancer.

If you're unsure whether your internal medical necessity templates reference the correct NCD section, check now — before your next claim drops. A prior authorization request citing a retired NCD section won't necessarily get denied outright, but it adds friction. Medicare Administrative Contractors notice inconsistencies, and that friction has a cost.

The CMS coverage policy for FDG PET is part of the diagnostic tests benefit category. This applies broadly across Medicare fee-for-service. If your patients are in Medicare Advantage plans, those plans may apply additional criteria beyond the NCD floor — check plan-level coverage policy documents separately.

Coverage Indications at a Glance

The retired section 220.6.11 contained no active coverage criteria — it was administratively removed and replaced. The table below reflects the current state of NCD 302 as of the January 9, 2026 effective date.

This policy does not list specific CPT or HCPCS codes in the NCD 302 / 220.6.11 retirement notice. Code-level billing guidelines live in section 220.6.17 and the parent PET scans NCD (§220.6). Cross-reference those sections for active code coverage.

CMS FDG PET Thyroid Cancer Billing Guidelines and Action Items 2026

The administrative nature of this change doesn't mean you can ignore it. Here's what to do.

If your organization has high FDG PET volume for thyroid cancer patients, loop in your compliance officer before the next billing cycle. The coverage criteria themselves haven't changed, but a documentation audit now is cleaner than a claim denial later.

CPT, HCPCS, and ICD-10 Codes for FDG PET Thyroid Cancer Under NCD 302

The retirement notice for NCD 302 / section 220.6.11 does not list specific CPT, HCPCS, or ICD-10 codes. This is consistent with how CMS handles retired NCD sections — the code-level billing guidelines move with the active section.

For FDG PET thyroid cancer billing under Medicare, the applicable codes are governed by section 220.6.17 and the parent NCD for PET Scans (§220.6). Go to those sections directly for current code tables.

Where to find the active code guidance:

• CMS NCD Manual, Section 220.6.17 — FDG PET for Thyroid Cancer (active)
• CMS NCD for PET Scans (§220.6) — parent policy covering all FDG PET indications
• CMS Medicare Coverage Database: PET Scans NCD

Do not bill under codes or criteria listed in section 220.6.11. That section is retired. Any claim documentation tied to 220.6.11 after April 3, 2009 references a policy that no longer exists in the NCD Manual.

Why This "Administrative" Change Still Matters for Your Revenue Cycle

I'll be direct: this is one of those updates that looks like a non-event and quietly causes problems. CMS has been carrying 220.6.11 as a ghost section for over 15 years — the replacement happened in 2009, but the formal retirement didn't land until the March 2023 revision and now the January 2026 update in NCD 302. That's a long time for stale documentation to accumulate in billing guides across the country.

The risk isn't a wave of new claim denials. The risk is that your team's internal documentation is out of sync with the NCD Manual, and that inconsistency surfaces at the worst possible time — during a MAC audit, a prior authorization dispute, or a payer appeal where the specific NCD section cited in your paperwork gets scrutinized.

FDG PET thyroid cancer billing involves enough clinical complexity that your documentation needs to be clean. These scans are expensive, often preceded by prior authorization requirements at the plan level, and subject to scrutiny on medical necessity grounds. A wrong section reference doesn't help your case.

The real action item is simple: treat this as a documentation hygiene trigger. The underlying coverage policy didn't move. Your references to it need to.