Beta Amyloid Positron Tomography in Dementia and Neurodegenerative Disease (RETIRED) — NCD 356 | CMS Coverage Update

TL;DR: The Centers for Medicare & Medicaid Services modified NCD 356 — the beta amyloid PET coverage policy — effective October 13, 2023, with this update formally logged in CMS systems on January 9, 2026. Coverage decisions for PET beta amyloid imaging now sit with Medicare Administrative Contractors, not a national coverage requirement. Here's what that means for your billing team.

CMS retired NCD 220.6.20, which had governed PET beta amyloid imaging under a Coverage with Evidence Development (CED) framework. That retirement ended the CED requirement entirely. Your MAC now controls whether PET beta amyloid imaging is covered for your patients — and that changes how you document, bill, and check authorization before the scan ever happens.

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Quick-Reference Table

Field	Detail Copy
Payer	CMS
Policy	Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease (RETIRED)
Policy Code	NCD 356
Change Type	Modified
Effective Date	October 13, 2023 (formally updated in CMS systems January 9, 2026)
Impact Level	High
Specialties Affected	Neurology, Nuclear Medicine, Radiology, Geriatrics
Key Action	Contact your MAC to confirm local coverage policy for PET beta amyloid imaging before billing

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CMS PET Beta Amyloid Imaging Coverage Criteria and Medical Necessity Requirements 2026

This is the policy change that billing teams in neurology and nuclear medicine have been waiting for — and many still haven't adjusted their workflows to reflect it.

For years, PET beta amyloid imaging operated under CED. That meant coverage was conditional on patients being enrolled in an approved clinical study. No study enrollment, no coverage. Full stop.

CMS ended that framework on October 13, 2023, when it retired NCD 220.6.20. The CMS beta amyloid PET coverage policy no longer requires CED enrollment. Coverage determinations now fall to your Medicare Administrative Contractor under section 1862(a)(1)(A) of the Social Security Act.

What does that mean practically? Your MAC decides whether PET beta amyloid imaging is reasonable and necessary for your patient population. Medical necessity criteria will vary by contractor. Palmetto GBA, Novitas, CGS, WPS — each one can set its own local coverage determination (LCD) for this service.

If your practice spans multiple MAC jurisdictions, you may face different documentation and medical necessity standards in each one. That's not a hypothetical problem — it's the direct result of CMS moving this to local authority.

Check your MAC's current LCD for beta amyloid PET imaging before billing. If your MAC hasn't issued one yet, that creates a coverage gap you need to understand before you schedule scans and bill Medicare. Talk to your compliance officer if the local LCD status is unclear for your jurisdiction — billing without confirmed coverage puts you at claim denial risk.

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Coverage Indications at a Glance

Indication	Status	Relevant Codes	Notes Copy
PET beta amyloid imaging — CED enrollment required	No Longer Required	N/A	NCD 220.6.20 retired effective 10/13/2023
PET beta amyloid imaging — MAC coverage determination	MAC-Dependent	Contact your MAC	Coverage determined under section 1862(a)(1)(A); LCD may or may not exist in your jurisdiction

This policy does not list specific CPT or HCPCS codes. The policy data for NCD 356 contains no code-level detail. Your MAC's LCD — or absence of one — governs which codes are billable and under what conditions.

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CMS PET Beta Amyloid Imaging Billing Guidelines and Action Items 2026

The shift from national CED to local MAC authority sounds like a win. In some ways it is — you're no longer locked out of coverage just because a patient isn't enrolled in a qualifying study. But the operational complexity just increased. Here's what to do now.

1. Pull your MAC's current LCD for beta amyloid PET imaging.

Don't assume coverage exists because the CED requirement is gone. Your MAC may have issued an LCD with specific medical necessity criteria, documentation requirements, and covered diagnoses. Find it, read it, and give it to your billing team before the next scan goes out.

2. Confirm whether your MAC has issued an LCD at all.

Some MACs moved quickly after the October 13, 2023 effective date. Others haven't. If your MAC has no LCD for this service, you're operating in a coverage gap. That means heightened claim denial risk on every PET beta amyloid scan you bill to Medicare. Flag this with your compliance officer immediately.

3. Update your charge capture and billing workflows to reflect the new authority structure.

PET beta amyloid billing is no longer governed by a single national standard. Your team needs to know which MAC jurisdiction each claim falls under, and what that MAC requires for coverage. If you bill across jurisdictions, build a reference sheet by MAC with the relevant LCD numbers and criteria.

4. Audit any claims denied under the old CED framework.

If your practice had claims denied prior to October 13, 2023 because patients weren't enrolled in a CED study, review those carefully. The CED requirement is gone. Depending on the denial date and circumstances, some of those claims may be worth reopening. Talk to your billing consultant about the timeline and process for reopening denied claims.

5. Document medical necessity at the patient level, not the study level.

Under CED, coverage was tied to study enrollment documentation. Now it's tied to individual medical necessity. Your providers need to document why PET beta amyloid imaging is reasonable and necessary for each specific patient — following whatever criteria your MAC publishes. The clinical narrative in the chart has to support the claim.

6. Check prior authorization requirements with your MAC.

Prior authorization requirements for PET imaging vary by MAC and by plan. Don't assume the old CED framework covered prior auth either — the rules have changed. Verify prior auth requirements for beta amyloid PET under your specific MAC before scheduling.

7. Watch for reimbursement rate changes.

The CED framework didn't create a special reimbursement rate — PET beta amyloid imaging reimbursement was always governed by the Medicare Physician Fee Schedule. But if your MAC's LCD restricts covered indications or adds documentation requirements, your effective reimbursement rate may shift as more claims are reviewed or denied. Monitor your denial rate on these claims in the first 90 days after implementing your new workflow.

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CPT, HCPCS, and ICD-10 Codes for Beta Amyloid PET Imaging Under NCD 356

The policy data for NCD 356 does not list specific CPT, HCPCS, or ICD-10 codes. This is not an oversight in our coverage — the CMS policy document itself contains no code-level detail.

This matters for your billing team. The absence of codes in the NCD means code-level guidance lives entirely at the MAC level. Your MAC's LCD — or local article — is where you'll find the specific CPT codes for PET beta amyloid imaging, along with any covered ICD-10 diagnosis codes and billing instructions.

Contact your MAC directly or search their LCD database at cms.gov/medicare-coverage-database to find the applicable local coverage determination. When you find it, note the LCD number, the effective date, and any associated billing articles.

If you're not sure which MAC jurisdiction applies to your claims, the CMS MAC jurisdiction map is your starting point. Get that right before you pull any LCD — a billing guideline from the wrong MAC won't protect you on audit.

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What This Change Actually Means for Billing Teams

Here's the honest take: the retirement of the CED requirement for PET beta amyloid imaging is genuinely good news for patient access. Clinicians can now order these scans for appropriate Medicare patients without the administrative burden of study enrollment. That's a meaningful improvement.

But the shift to MAC-level authority creates fragmentation that billing teams have to manage. The CMS beta amyloid PET coverage policy is now 15 different policies in practice — one per MAC jurisdiction. Your billing team needs to track multiple LCDs, multiple prior authorization requirements, and potentially multiple claim submission processes.

The operational lift is real. Don't underestimate it.

The January 9, 2026 update to NCD 356 in CMS systems doesn't change the October 13, 2023 effective date — but it's a signal that CMS is maintaining this policy as the governing framework. If your team hasn't fully transitioned workflows away from CED-era processes, the appearance of this update in CMS policy tracking systems is a good forcing function.

Get your MAC's LCD. Update your documentation templates. Brief your providers on what medical necessity documentation looks like for PET beta amyloid imaging under the new local framework. Then audit your denial rate on these claims after 60 days to see if your new process is working.

If this service is a significant part of your volume — particularly in neurology or nuclear medicine — loop in your compliance officer before your next billing cycle. The stakes on getting MAC-level coverage determinations wrong are high enough to warrant the conversation.

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