CMS Retired NCD 220.6.6 for FDG PET in Melanoma — What Billing Teams Need to Know in 2026
TL;DR: The Centers for Medicare & Medicaid Services formally retired NCD 220.6.6, the FDG PET for melanoma coverage policy, replacing it with section 220.6.17. This retirement has been in effect since April 2009, but the section was only officially removed from the NCD Manual in 2023 — and the administrative record was updated again on January 9, 2026.
If your billing team is still referencing NCD 220.6.6 for FDG PET melanoma claims, you're citing a retired section. The governing authority moved to NCD 220.6.17 over 15 years ago. Here's what that means for your workflow.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS (Centers for Medicare & Medicaid Services) |
| Policy | FDG PET for Melanoma (Replaced with Section 220.6.17) — RETIRED |
| Policy Code | NCD 304 / Section 220.6.6 |
| Change Type | Modified (Section retired and removed from NCD Manual) |
| Effective Date | April 10, 2023 (original retirement: April 3, 2009; record updated January 9, 2026) |
| Impact Level | Medium — low operational impact if you're already billing under 220.6.17, but high risk if you're not |
| Specialties Affected | Oncology, Nuclear Medicine, Radiology, Dermatology (surgical oncology) |
| Key Action | Confirm all FDG PET melanoma claims reference NCD 220.6.17, not the retired 220.6.6 |
CMS FDG PET Melanoma Coverage Criteria and Medical Necessity Requirements 2026
Here's the core issue: CMS melanoma FDG PET coverage policy did not disappear. It moved. Section 220.6.6 was retired effective April 3, 2009, and replaced by the broader PET scans NCD under section 220.6.17.
The Centers for Medicare & Medicaid Services officially removed 220.6.6 from the NCD Manual with a revision issued March 9, 2023, effective April 10, 2023. The January 9, 2026 update is an administrative record change — not a new clinical policy shift. But it signals that CMS is actively cleaning up its NCD Manual, and outdated references in your billing documentation are now a real liability.
If you're billing FDG PET for melanoma and want to understand medical necessity criteria, you need to look at NCD 220.6.17 — not 220.6.6. Section 220.6.6 no longer exists as a functional policy. Any claim denial tied to a reference to the retired section is a documentation problem you created.
The broader PET scan NCD (§220.6) and its subsection 220.6.17 govern whether FDG PET imaging for melanoma meets medical necessity under Medicare. Your billing guidelines and clinical documentation should reference those sections exclusively.
CMS FDG PET Melanoma Exclusions and Non-Covered Indications
Section 220.6.6 itself contains no active coverage or exclusion criteria — it was retired. The retired section simply redirects to 220.6.17.
Any exclusions, non-covered indications, or prior authorization requirements for FDG PET melanoma billing now live entirely within NCD 220.6.17 and the parent NCD 220.6. Pull your coverage policy documentation from those sources. Do not carry forward any coverage interpretations based solely on 220.6.6 — that language no longer carries authority.
Coverage Indications at a Glance
Because section 220.6.6 is retired and contains no active clinical criteria, there are no independent coverage indications to report from this specific section. All FDG PET melanoma coverage determinations flow from NCD 220.6.17.
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| FDG PET for melanoma — all indications | Redirected to NCD 220.6.17 | See NCD §220.6.17 | Section 220.6.6 retired April 3, 2009; removed from NCD Manual April 10, 2023 |
| FDG PET general coverage | Active under NCD §220.6 | See NCD §220.6 and §220.6.17 | Parent section remains active and governs all PET scan coverage policy |
This policy does not list specific CPT or HCPCS codes. FDG PET billing codes are addressed within NCD §220.6.17 and any applicable local coverage determinations issued by your Medicare Administrative Contractor.
CMS FDG PET Melanoma Billing Guidelines and Action Items 2026
The retirement of 220.6.6 is old news clinically, but the January 9, 2026 administrative update makes this a live issue for documentation audits. Here's what to do now.
| # | Action Item |
|---|---|
| 1 | Audit your internal policy references. Search your charge capture system, payer policy library, and any billing guidelines documents for references to NCD 220.6.6 or "section 220.6.6." Replace every instance with a reference to NCD 220.6.17 and the parent NCD §220.6. |
| 2 | Pull the current NCD 220.6.17 and read it. If your team hasn't reviewed the active FDG PET coverage policy recently, do it now. Medical necessity criteria, coverage indications, and any prior authorization requirements for FDG PET melanoma billing live there — not in the retired section. |
| 3 | Check your MAC for local coverage determinations. CMS sets national policy, but your Medicare Administrative Contractor may have issued an LCD that adds or restricts coverage for FDG PET in melanoma. National coverage determinations set the floor — LCDs can narrow it. Contact your MAC or search the Medicare Coverage Database for active LCDs in your jurisdiction. |
| 4 | Review any denied claims that cited 220.6.6. If your team has had a claim denial or coverage dispute tied to FDG PET melanoma billing in the past few years, check the documentation. If it referenced 220.6.6, that's a correctable documentation error. Resubmit with proper reference to 220.6.17 if the clinical criteria are otherwise met. |
| 5 | Update your coder and biller training materials. This retired section has been sitting in the NCD Manual in zombie form since 2009. That's long enough for incorrect references to get baked into training documents, superbills, and payer policy summaries. Correct the record before the next audit cycle. |
| 6 | Loop in your compliance officer if you've been billing on 220.6.6. If your team has been actively citing 220.6.6 as the governing authority on FDG PET melanoma claims — even in internal documentation — talk to your compliance officer about whether a look-back review makes sense. The reimbursement itself may be correct, but the documentation trail matters. |
| 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 Melanoma Under NCD 304
This policy does not list specific CPT, HCPCS, or ICD-10 codes. The retired section 220.6.6 contains no code-level billing data. All applicable codes for FDG PET melanoma billing are addressed in NCD §220.6.17 and the parent PET scans NCD (§220.6).
Where to Find the Applicable Codes
| Source | What It Contains |
|---|---|
| NCD §220.6 (PET Scans) | Parent policy governing all PET scan coverage, including applicable billing codes |
| NCD §220.6.17 | Active replacement for 220.6.6; contains FDG PET melanoma-specific coverage criteria and codes |
| Medicare Coverage Database | Full NCD text, cross-references, and claims processing instructions |
| Your MAC's LCD | Jurisdiction-specific code lists and coverage restrictions that may apply in your region |
Do not infer codes from the retired section. Pull your code list directly from NCD §220.6.17 and validate against your MAC's current guidance.
The Real Issue with This Update
The January 9, 2026 record update for NCD 304 is administratively minor. No new clinical policy was issued. No coverage criteria changed. CMS is cleaning up a retired section that has been functionally dead since April 2009.
But here's what's actually worth your attention: the fact that 220.6.6 survived in the NCD Manual in any form until 2023 — and that it's receiving another administrative touch in 2026 — tells you something. Outdated policy references have a long half-life in billing systems. They get copied into payer policy libraries, baked into charge capture workflows, and cited on appeal letters years after they stop mattering.
FDG PET melanoma billing is not a high-volume service for most practices, but it's high-dollar. A claim denial on a PET scan because your team cited a retired NCD section is an avoidable problem. The fix takes 30 minutes. Do it now.
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