TL;DR: CMS retired NCD 305 (section 220.6.7) for FDG PET in head and neck cancers, replacing it with section 220.6.17 — a change that took effect April 3, 2009, but was formally removed from the NCD Manual on April 10, 2023. If your billing team is still referencing NCD 305 for FDG PET head and neck claims, you're working from a dead policy document.
The Centers for Medicare & Medicaid Services updated NCD 305 on January 9, 2026, to reflect the formal retirement of section 220.6.7 governing FDG PET coverage for head and neck cancers. The operative guidance now lives entirely in section 220.6.17, which consolidated FDG PET coverage under the broader PET Scans NCD (§220.6). No specific CPT or HCPCS codes are listed in the retired policy document itself — all applicable code-level guidance is in §220.6.17.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS |
| Policy | FDG PET for Head and Neck Cancers (Replaced with Section 220.6.17) — RETIRED |
| Policy Code | NCD 305 |
| Change Type | Modified (Retirement / Consolidation) |
| Effective Date | April 10, 2023 (formal removal); January 9, 2026 (latest revision) |
| Impact Level | Medium |
| Specialties Affected | Oncology, Radiology, Nuclear Medicine, ENT/Head & Neck Surgery |
| Key Action | Stop referencing NCD 305 / §220.6.7 for FDG PET head and neck claims — update all internal billing guidelines to point to §220.6.17 |
CMS FDG PET Head and Neck Cancer Coverage Criteria and Medical Necessity Requirements 2026
Here's the core issue: section 220.6.7 is gone. It has been gone since April 3, 2009. CMS formally pulled it from the NCD Manual on April 10, 2023. The January 9, 2026 update is the latest administrative revision confirming that retirement.
The CMS FDG PET head and neck cancer coverage policy now lives exclusively under section 220.6.17 of the NCD Manual. That section, part of the broader PET Scans NCD (§220.6), controls all coverage determinations, medical necessity criteria, and billing guidelines for FDG PET in head and neck cancer indications.
If your team has any internal documentation, charge capture templates, or prior authorization checklists that reference NCD 305 or §220.6.7 specifically, those references are stale. Using retired policy language in appeals or medical necessity documentation creates unnecessary exposure.
The real issue with a retirement like this is not the clinical change — FDG PET coverage for head and neck cancers didn't fundamentally disappear. The risk is administrative drift. Teams that built workflows around §220.6.7 and never updated them may be citing a retired section in documentation, appeals letters, or payer correspondence without realizing it.
For prior authorization purposes, §220.6.17 is the governing document. If a payer correspondent or MAC asks you to cite the applicable NCD, §220.6.7 is not the right answer. Point to §220.6.17 and the PET Scans NCD at §220.6.
Medical necessity determinations for FDG PET in head and neck cancer still require alignment with Medicare's coverage criteria — but you need to verify those criteria against §220.6.17, not the retired §220.6.7. The two sections may overlap significantly, but the retired section carries no weight in a coverage dispute.
Coverage Indications at a Glance
Because section 220.6.7 is retired and no longer contains active coverage criteria, the table below reflects the policy's current status. All active indication-level coverage guidance is in §220.6.17.
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| FDG PET for head and neck cancers (under §220.6.7) | Retired / No longer operative | None listed in retired NCD 305 | All coverage criteria moved to §220.6.17 effective April 3, 2009 |
| FDG PET for head and neck cancers (under §220.6.17) | Active — see §220.6.17 | See PET Scans NCD §220.6 | This is the operative coverage policy — reference this section for all claims and appeals |
CMS FDG PET Billing Guidelines and Action Items 2026
This is a housekeeping change with real operational teeth if your team hasn't caught it. Here's what to do now.
| # | Action Item |
|---|---|
| 1 | Audit your internal billing guidelines now. Search every policy document, charge capture template, and appeal letter template your team uses for any reference to "NCD 305," "§220.6.7," or "section 220.6.7." Replace those references with §220.6.17 and the active PET Scans NCD (§220.6). |
| 2 | Update your payer correspondence templates before your next FDG PET head and neck claim goes out. Any medical necessity letter or appeal that cites §220.6.7 cites a retired policy. That's a detail a payer's utilization management team can — and sometimes will — use against you. |
| 3 | Verify your MAC's local coverage determination guidance. The NCD sets the floor, but your Medicare Administrative Contractor may have issued additional guidance under §220.6.17. Check your MAC's website for any LCD or article that references FDG PET in head and neck cancers. Regional requirements can layer on top of the national coverage policy. |
| 4 | Pull the current §220.6.17 criteria and compare them to what your team has been following. If your team built its FDG PET head and neck cancer billing workflow before April 2009, the criteria your team knows may not match what §220.6.17 actually says. Confirm the medical necessity thresholds, documentation requirements, and any frequency limitations are current. |
| 5 | Update prior authorization request language. When submitting prior auth requests for FDG PET in head and neck cancer cases, cite §220.6.17 explicitly. CMS and Medicare Advantage plans that follow NCD guidance will recognize the active section — not the retired one. |
| 6 | Brief your coding and clinical documentation team. Physicians and coders who document medical necessity for FDG PET orders should know that §220.6.7 is retired. If a physician's order or clinical note references the old section as justification, that's a documentation gap worth correcting before claim submission. |
If your organization does significant FDG PET billing for head and neck cancer patients and you're unsure how well your current workflow maps to §220.6.17, loop in your compliance officer or a billing consultant before your next audit cycle. A retired policy reference in medical necessity documentation is a minor issue until it shows up in a payer audit — then it becomes a bigger conversation.
| 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 Head and Neck Cancers Under NCD 305
Covered CPT Codes
The retired NCD 305 policy document does not list specific CPT or HCPCS codes. CMS did not include code-level detail in the §220.6.7 retirement notice. All applicable CPT and HCPCS codes for FDG PET billing — including codes used for head and neck cancer indications — are governed by the active PET Scans NCD at §220.6 and section 220.6.17 specifically.
| Code | Type | Description |
|---|---|---|
| Not specified in NCD 305 | — | See §220.6.17 and the active PET Scans NCD (§220.6) for all applicable codes |
A Note on Code Lookup for FDG PET Billing
This is not a case where the payer is removing codes from coverage. The codes themselves — whatever CPT codes your team uses for FDG PET in head and neck cancer — are addressed in the active policy at §220.6.17. The retirement of §220.6.7 was a policy consolidation, not a code-level coverage change.
Your revenue cycle team should pull the current code list directly from §220.6.17 and the CMS Medicare Coverage Database entry for the PET Scans NCD. Cross-reference that against your charge master to confirm your FDG PET head and neck codes are still correctly mapped to an active coverage policy and not orphaned to a retired NCD section.
If you're seeing claim denial rates increase on FDG PET head and neck cases, this administrative mismatch — citing a retired policy — is one of the first things to rule out. It's a solvable problem, but only if your team knows to look for it.
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