Abdomen Imaging Guidelines

Covers modality‑specific abdominal and pelvic imaging (CT, MRI, ultrasound, MRCP, HIDA, nuclear studies, enterography, CT colonography, etc.) for a wide range of abdominal conditions with defined size-, symptom- and lab‑based criteria, while excluding investigational techniques (e.g., quantitative MR tissue composition codes, routine 3D/4D ultrasound rendering, certain MR elastography uses, non‑billable handheld Doppler, and PET for sclerosing mesenteritis) and generally discouraging routine surveillance imaging for asymptomatic/stable findings. Key requirements: a documented current clinical evaluation within 60 days plus specified preliminary labs and prior non‑advanced imaging are required before approving advanced imaging unless predefined "red flag" findings are present, and requests must include condition‑specific documentation (scores, labs, prior imaging, pregnancy status/contrast rationale, biopsy plans, etc.).

"A current clinical evaluation (within 60 days) is required before advanced imaging can be considered (history, physical exam, appropriate laboratory studies, non-advanced imaging such as plain x-ra..."