Pediatric Pelvis Imaging Guidelines

This policy covers pediatric pelvis imaging—including transabdominal and transvaginal ultrasound, pelvic MRI (with/without contrast) and fetal pelvis MRI—for pediatric patients (<18) presenting with common pelvic signs and symptoms such as pelvic pain, abnormal uterine bleeding, PID, endometriosis, suspected adnexal mass, undescended testis, and scrotal or penile pathology. Major limitations/requirements: ultrasound (preferably transabdominal in all pediatric patients; transvaginal only for those who are sexually active or use a tampon and consent) should be the initial study, advanced imaging is not for asymptomatic screening, repeat exams require evidence of change, atypical presentations require physician review, and a face-to-face evaluation within 60 days is required before advanced imaging.

"Penis - Soft Tissue Mass"

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