Key facts for NCD 220.6.19
- Benefit category
- Diagnostic Tests (other)
- Effective date
- 12/15/2021
- Implemented 01/17/2022
- Transmittal
- Transmittal 11158
- Versions published
- 2
- Manual chapter
- 220
- NCD Manual (Pub. 100-03)
TL;DR
NCD 220.6.19 sets Medicare's national policy for positron emission tomography (naf-18) to identify bone metastasis of cancer under the benefit category "Diagnostic Tests (other)", effective 12/15/2021 and implemented 01/17/2022. The confirmatory analyses were not published during the 24-month time period. Therefore, effective December 15, 2017, CMS determines that there are no nationally covered indications for PET NaF-18. It has been revised 1 time since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
Positron Emission Tomography (PET) is a minimally-invasive, diagnostic imaging procedure that assesses the level of metabolic activity and perfusion in various organ systems of the body. A positron camera (tomograph) is used to produce cross-sectional tomographic images, which are obtained from positron-emitting radioactive tracer substances (radiopharmaceuticals) such as F-18 sodium fluoride (NaF-18).
Indications and limitations of coverage
B. Nationally Covered Indications
The confirmatory analyses were not published during the 24-month time period. Therefore, effective December 15, 2017, CMS determines that there are no nationally covered indications for PET NaF-18.
C. Nationally Non-Covered Indications
Effective December 15, 2017, CMS determines that PET NaF-18 PET is nationally non-covered.
D. Other
Other PET radiopharmaceutical tracers for cancer can be covered at local Medicare Administrative Contractor discretion when used according to their FDA-approved indication(s).
(This NCD last reviewed December 2017.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 220.6.19 version 2. View the original on cms.gov.
Revision history
06/2022 - Transmittal 10832, dated June 2, 2021, is being rescinded and replaced by Transmittal 11453, dated, June 10, 2022, to revise NCD 90.2, NGS, revises business requirement 12124.2 and 12124.2.1 and its associated spreadsheet of coding by retainining all ICD-10 NOC diagnosis codes proposed for deletion effective July 1, 2022. ( TN 11453 ) (CR12124)
12/2021 - The purpose for this change request is to update the NCD manual language to reflect that effective December 15, 2017, following the 24-month extension and absent any published, peer-reviewed journals regarding PET NaF-18 to identify bone metastases of cancer, NCD 220.6.19 reverted to a non-coverage determination. ( TN 11158 ) (CR12526)
06/2021 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. ( TN 10832 ) (CR12124)
05/2021 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. ( TN 10804 ) (CR12124)
03/2021 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. ( TN 10624 ) (CR12124)
02/2020 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
Previous NCD coding changes appear in ICD-10 quarterly updates that can be found at: https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html , along with other CRs implementing new policy NCDs. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates. Any policy-related changes to NCDs continue to be implemented via the current, longstanding NCD process. ( TN 2439 ) (CR11655)
03/2013 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy. Implementation date: 10/07/2013 Effective date: 10/1/2015. ( TN 1199 ) ( TN 1199 ) (CR 8197)
03/2010 - CMS proposes that the evidence is not sufficient to determine that the results of NaF-18 PET imaging to identify bone metastases improve health outcomes of beneficiaries with cancer. Therefore CMS proposes that this use is not reasonable and necessary under Section 1862(a)(1)(A) of the Social Security Act (the Act). Effective date: 02/26/2010. Implementation date: 07/06/2010. ( TN 119 ) (CR6861)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 220.6.19
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 220.6.19
What does NCD 220.6.19 cover?
The confirmatory analyses were not published during the 24-month time period. Therefore, effective December 15, 2017, CMS determines that there are no nationally covered indications for PET NaF-18. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 220.6.19 take effect?
The current version (2) is effective 12/15/2021, implemented 01/17/2022, published in transmittal 11158. CMS lists 2 versions of this NCD.
Does a Local Coverage Determination override NCD 220.6.19?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.