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LCDs and LCAs
by Contractor

PLA Codes

Laboratory Fee Schedule

2024
2023

Physician Fee Schedule

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OPPS Fee Schedule

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APC Codes

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April 2024
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CMS Transmittals




National Coverage Determination
Procedure Code: 8XXXX
FDG PET for Head and Neck Cancers
CMS Policy Number: 220.6.17
Back to NCD List

Other:
NOTE: Whenever a personal history diagnosis code (Z85.XXX) is on a claim, the claim must also contain a diagnosis code from the list of covered C, D, or R diagnosis codes.



To review all requirements of this policy, please see: CMS NCD listing by Chapter

Covered ICD-10 Codes.

C00.0Malignant neoplasm of external upper lip
C00.1Malignant neoplasm of external lower lip
C00.3Malignant neoplasm of upper lip, inner aspect
C00.4Malignant neoplasm of lower lip, inner aspect
C00.6Malignant neoplasm of commissure of lip, unspecified
C00.8Malignant neoplasm of overlapping sites of lip
C01Malignant neoplasm of base of tongue
C02.0Malignant neoplasm of dorsal surface of tongue
C02.1Malignant neoplasm of border of tongue
C02.2Malignant neoplasm of ventral surface of tongue
.... and many more.


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