TL;DR: CMS retired NCD 220.6.12 for FDG PET imaging in soft tissue sarcoma and replaced it with NCD section 220.6.17. If your team still references the old section number in billing workflows, documentation templates, or prior authorization checklists, update them now.
CMS — formally, the Centers for Medicare & Medicaid Services — modified NCD 303 on January 9, 2026, to reflect that section 220.6.12 governing FDG PET for soft tissue sarcoma was removed from the NCD Manual. The replacement section, 220.6.17, has been the operative coverage policy since April 3, 2009. The policy does not list specific CPT or HCPCS codes. This update is largely administrative — but that doesn't mean your billing team can ignore it.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS (Centers for Medicare & Medicaid Services) |
| Policy | FDG PET for Soft Tissue Sarcoma — NCD 220.6.12 (RETIRED), replaced by NCD 220.6.17 |
| Policy Code | NCD 303 |
| Change Type | Modified (retirement of old section, redirect to replacement) |
| Effective Date | April 10, 2023 (formal retirement); cross-reference live since April 3, 2009 |
| NCD Manual Update | Rev. 11892, Issued 03-09-23 |
| Impact Level | Low — administrative cleanup, but operationally relevant if your workflows cite 220.6.12 |
| Specialties Affected | Oncology, Nuclear Medicine, Radiation Oncology, Orthopedic Oncology |
| Key Action | Replace all references to NCD 220.6.12 with NCD 220.6.17 in billing documentation, templates, and prior auth workflows |
CMS FDG PET Soft Tissue Sarcoma Coverage Criteria and Medical Necessity Requirements 2026
Here's the honest summary of what this NCD 303 CMS update actually says: section 220.6.12 is gone. It was removed from the NCD Manual effective April 10, 2023, and replaced by section 220.6.17, which became operative back in April 2009.
That means if your team is still citing 220.6.12 in any documentation, you're referencing a section that hasn't existed in the NCD Manual for nearly two years. That's a problem — not because claims will auto-deny based on a section number, but because audit trails and medical necessity documentation need to point to the current governing authority.
The current CMS FDG PET coverage policy for soft tissue sarcoma lives entirely under NCD 220.6.17, which is part of the broader PET Scans NCD (§220.6). For medical necessity determinations, clinical criteria, and coverage indications, your team should go directly to that section. The retired 220.6.12 is a dead end.
CMS doesn't specify prior authorization requirements at the NCD level for FDG PET — that determination often falls to your Medicare Administrative Contractor (MAC). Check with your MAC to confirm whether prior authorization applies in your region for FDG PET in soft tissue sarcoma cases before submitting claims.
Coverage Indications at a Glance
Because section 220.6.12 is retired and carries no active clinical criteria, the table below reflects the status of FDG PET for soft tissue sarcoma under the NCD 303 framework as currently structured.
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| FDG PET for soft tissue sarcoma — covered indications | Refer to NCD 220.6.17 | Not specified in NCD 303 policy data | Active coverage criteria live under §220.6.17, not the retired §220.6.12 |
| FDG PET billed under retired section 220.6.12 | Not applicable — section retired | Not specified | Do not reference 220.6.12 in billing documentation or medical necessity letters |
The policy data for NCD 303 does not list specific CPT or HCPCS codes. Coverage and coding guidance for FDG PET in soft tissue sarcoma is governed by NCD §220.6 and §220.6.17. Pull your clinical criteria and coding guidance from that source.
CMS FDG PET Soft Tissue Sarcoma Billing Guidelines and Action Items 2026
This is an administrative retirement, but "administrative" doesn't mean "ignore it." Here's what your team needs to do.
| # | Action Item |
|---|---|
| 1 | Update every internal document that references NCD 220.6.12. Check billing templates, charge capture tools, prior authorization forms, and payer correspondence templates. Replace 220.6.12 with 220.6.17 everywhere it appears. Do this before your next FDG PET claim goes out the door. |
| 2 | Pull NCD §220.6.17 and review it now. If your team has been operating off cached knowledge of the old 220.6.12 criteria, you may be working from outdated medical necessity standards. The operative section is §220.6.17. Read it. Confirm your documentation matches what it requires. |
| 3 | Check your MAC's local coverage policies. CMS national coverage determinations set the floor, but your Medicare Administrative Contractor can layer additional requirements on top. FDG PET billing guidelines in your region may differ. Contact your MAC or check their LCD database to confirm there are no additional prior authorization or documentation requirements for soft tissue sarcoma cases. |
| 4 | Audit recent claims for citation accuracy. If your team has submitted claims in the past 12-24 months with documentation citing NCD 220.6.12, review whether any of those claims triggered a claim denial or are in an open audit. A reference to a retired section won't automatically cause a denial — but it can raise questions during a post-payment audit. Clean documentation always wins. |
| 5 | Update your denial management workflow. If your team receives a denial on an FDG PET claim for soft tissue sarcoma and the denial references coverage policy questions, your appeal should cite NCD §220.6.17 — not the retired section. Make sure your appeals team knows this. |
| 6 | Confirm reimbursement rates with your MAC's fee schedule. NCD 303 doesn't address reimbursement directly. FDG PET reimbursement under Medicare runs through the PET scan fee schedule, and rates can vary by setting and geography. Confirm current reimbursement levels with your MAC if you haven't done so recently. |
If you're unsure how this change interacts with your specific payer mix or documentation practices, talk to your compliance officer before your next billing cycle. This is low-stakes at face value — but a small documentation error on a high-cost imaging study gets expensive fast.
| 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 Soft Tissue Sarcoma Under NCD 303
Covered CPT Codes
The NCD 303 policy data does not list specific CPT or HCPCS codes. FDG PET soft tissue sarcoma billing should reference NCD §220.6 and §220.6.17 for applicable code guidance.
| Code | Type | Description |
|---|---|---|
| Not specified | — | No codes listed in NCD 303 policy data. See NCD §220.6 (PET Scans) for applicable codes. |
Key ICD-10-CM Diagnosis Codes
The NCD 303 policy data does not list ICD-10-CM diagnosis codes. Soft tissue sarcoma diagnosis coding should align with the clinical criteria in NCD §220.6.17.
| Code | Description |
|---|---|
| Not specified | — |
Important: Do not use the absence of codes in NCD 303 as a billing free-for-all. CMS's broader PET scan coverage policy (§220.6) governs which codes apply. Build your charge capture from that source — not from NCD 303's administrative retirement notice.
The Real Issue with This Policy Change
Most billing teams will scan this update, see "retired," and move on. That's the wrong call.
The reason this matters is that NCD Manual section numbers show up in appeal letters, in medical necessity documentation, and in compliance audit files. If your team has a habit of citing the NCD section number in clinical notes or payer correspondence, you're now citing a dead section — and that weakens your position in an audit or appeal.
This is similar to any situation where a payer quietly redirects a coverage policy to a new section number. The clinical rules may not change, but your paper trail needs to match current policy. Auditors notice this stuff.
The FDG PET soft tissue sarcoma billing landscape under Medicare has always required careful documentation. PET imaging for sarcoma is high-cost, episodic, and scrutinized. An appeal that cites an invalidated section of the NCD Manual sends the wrong signal — even if the underlying clinical criteria support coverage.
Update your references. Cross-check with §220.6.17. Move on. It takes 30 minutes and it closes a real documentation risk.
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