Pediatric Spine Imaging Guidelines

This policy covers pediatric spine imaging—advanced modalities including MRI, CT, PET-related codes, bone marrow and nuclear bone scans (SPECT) —for common pediatric spine symptoms and symptom complexes. It applies to pediatric patients (<18 years) with typical presentations (infants and most children <7 years or those developmentally delayed generally require anesthesia), requires basic imaging first and a recent (within 60 days) face-to-face evaluation before advanced imaging unless guideline-supported follow-up, does not support imaging of asymptomatic patients, excludes certain PET codes for pediatrics, and mandates physician review for atypical presentations or repeat studies without evidence of progression.

"Nuclear Bone Scan Limited — CPT 78300"

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