Summary: The Centers for Medicare & Medicaid Services modified its xenon scan coverage policy, retiring the policy entirely, with an effective date of June 16, 2026. Here's what billing teams need to do before that date.
CMS xenon scan coverage policy has been on the books for decades. The retirement of this policy signals that CMS no longer considers a standalone national coverage determination necessary for xenon-based diagnostic imaging — either because utilization has dropped to near-zero or because the technology has been formally superseded. This policy does not list specific CPT or HCPCS codes. If your practice still bills for xenon ventilation studies, the removal of this coverage policy creates real reimbursement and claim denial exposure you need to address now.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS |
| Policy | Xenon Scan — RETIRED |
| Policy Code | N/A |
| Change Type | Modified (Retirement) |
| Effective Date | June 16, 2026 |
| Impact Level | Medium — low volume but high denial risk for remaining billers |
| Specialties Affected | Pulmonology, nuclear medicine, radiology |
| Key Action | Audit your charge capture for xenon scan billing before June 16, 2026, and confirm MAC-level coverage guidance is still active |
CMS Xenon Scan Coverage Criteria and Medical Necessity Requirements 2026
The Centers for Medicare & Medicaid Services is retiring its national xenon scan coverage policy on June 16, 2026. This is not a minor edit to coverage criteria. The entire policy is being pulled.
For billing teams, the retirement of a coverage policy doesn't automatically mean the procedure is non-covered. It means CMS is removing the national-level framework that defined medical necessity for xenon scans. What fills that gap — if anything — depends on your Medicare Administrative Contractor.
Xenon-133 ventilation scans are a nuclear medicine procedure used to assess pulmonary function. They've been a tool for evaluating lung ventilation, particularly in patients being assessed for pulmonary embolism or obstructive lung disease. In practice, technetium-based agents and CT pulmonary angiography have largely replaced xenon scans over the past 20 years. The retirement of this coverage policy reflects that clinical reality.
Whether xenon scan billing is covered under Medicare after June 16, 2026 depends entirely on whether your MAC has issued or maintains a local coverage determination. Without a national policy, there's no federal backstop for medical necessity. Claims that previously relied on the CMS national policy for coverage support will need a different justification — or they'll get denied.
This policy does not list specific CPT or HCPCS codes. Xenon ventilation scans have historically been billed under nuclear medicine procedure codes, but CMS has not published a code list with this retirement notice. Contact your MAC directly to confirm which codes were covered under this policy and what, if any, LCD governs those codes going forward.
Prior authorization was not specifically addressed in this policy change. However, the absence of a national coverage determination makes prior auth more important, not less. If your payer mix includes Medicare Advantage plans that reference CMS policy for their own coverage rules, those plans may shift their criteria after June 16, 2026.
CMS Xenon Scan Exclusions and Non-Covered Indications
With the retirement of this coverage policy, CMS is not publishing a new list of exclusions. The policy simply goes away.
That creates ambiguity. Procedures that were previously covered under the national policy framework now have no CMS-level coverage determination behind them. That's effectively a coverage gap, not a blanket exclusion — but the billing outcome is the same. Without a supporting LCD from your MAC, a claim for a xenon scan has no national coverage anchor.
The real risk here is for practices that have been billing xenon scans infrequently — maybe once or twice a quarter — without closely tracking the policy. Those claims may have been passing through on old coverage logic. After June 16, 2026, that logic disappears.
Coverage Indications at a Glance
Because this policy does not include specific codes or indication-level criteria, the table below reflects the coverage status based on the policy retirement itself. Do not treat this as an exhaustive MAC-level coverage determination.
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Xenon-133 ventilation scan — any indication | Uncertain (national policy retired) | Not listed in policy data | MAC LCD governs after June 16, 2026; confirm with your MAC |
| Pulmonary ventilation assessment via xenon | Uncertain (national policy retired) | Not listed in policy data | No CMS medical necessity criteria remain at national level |
| Xenon scan as part of V/Q study | Uncertain (national policy retired) | Not listed in policy data | V/Q studies using technetium agents are not affected by this retirement |
CMS Xenon Scan Billing Guidelines and Action Items 2026
| # | Action Item |
|---|---|
| 1 | Audit your charge capture now. Search your last 24 months of claims for any xenon scan billing. If volume is zero, this retirement has no immediate billing impact. If you have active volume, you need MAC guidance before June 16, 2026. |
| 2 | Contact your MAC before June 16, 2026. Ask specifically whether a local coverage determination governs xenon scans in your jurisdiction. If your MAC has an LCD, get the policy number and confirm the medical necessity criteria. If there's no LCD, ask whether the procedure will require a written advance beneficiary notice (ABN) after the effective date. |
| 3 | Review your Medicare Advantage contracts. Some MA plans reference CMS national coverage policy directly in their coverage rules. The retirement of this policy may trigger a coverage review by those plans. Pull your MA plan contracts and check whether xenon scan reimbursement was tied to the national policy. |
| 4 | Update your internal billing guidelines. Remove any reference to CMS national coverage as the authority for xenon scan billing guidelines. Replace it with your MAC's LCD number — or document that no LCD exists. Your billing team should not be citing a retired policy to support a claim. |
| 5 | Flag prior authorization requirements with MA plans. If any Medicare Advantage plans in your network now require prior auth for xenon scans because the national policy is gone, you need to know that before a claim goes out. Call your MA plan provider relations contacts and ask directly. |
| 6 | Talk to your compliance officer if you have significant xenon scan volume. The retirement of a national coverage determination without a clear replacement is exactly the kind of ambiguous situation where a compliance review is worth the time. Don't assume your MAC coverage is intact without confirming it. If you're unsure how this applies to your payer mix, loop in your compliance officer before June 16, 2026. |
| 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 Xenon Scan Under This Policy
This policy does not list specific CPT, HCPCS, or ICD-10 codes. CMS did not publish a code set with the retirement notice.
Do not assume the absence of codes means there's no billing exposure. Xenon ventilation scans are billable procedures under nuclear medicine coding categories. The lack of a code list in this policy change means you need to do the research yourself — specifically with your MAC — to identify which codes were covered under the now-retired policy and whether those codes have MAC-level LCD support going forward.
What to Ask Your MAC
When you contact your Medicare Administrative Contractor, ask these three things:
- Which CPT or HCPCS codes were covered under the xenon scan national policy in your jurisdiction?
- Is there an active LCD covering those codes after June 16, 2026?
- If no LCD exists, what documentation or ABN requirements apply for Medicare claims?
Document the answers in writing. If your MAC gives you guidance verbally, follow up with a written request so you have a record. This protects your billing team if a claim denial comes through after the effective date.
What the Retirement of This Policy Really Means
Here's the honest take: xenon scans are a low-volume, aging technology. Most practices stopped billing them years ago. The retirement of this coverage policy is CMS cleaning house — removing a policy framework for a procedure that's largely been replaced by better imaging tools.
For the vast majority of billing teams, this change has zero day-to-day impact.
But for the practices that still perform xenon ventilation studies — typically academic medical centers, specialized pulmonology programs, or facilities that haven't updated their nuclear medicine protocols — this is a real issue. The retirement of a national coverage policy creates claim denial risk on a procedure that used to have clear Medicare coverage rules.
The other thing worth watching: this retirement could signal broader CMS attention to legacy nuclear medicine policies. If CMS is cleaning up outdated coverage determinations, xenon won't be the last one. Make sure your billing guidelines aren't relying on other older CMS policies that may be next on the retirement list.
Get the Full Picture
Track this policy across versions, search 1,500+ policies by CPT code, and get real-time alerts when any payer changes coverage.