Oncology Imaging Guidelines

This policy covers oncology imaging requests via the eviCore Clinical Decision Support Tool for a broad range of cancers (e.g., CNS, head and neck, lung, breast, colorectal, pancreatic, sarcomas, thyroid, neuroendocrine, renal, and many others), with adult (≥18) and pediatric (<18) guidelines applied based on age at initial diagnosis (AYA patients follow the age rule). Major limitations/requirements: atypical presentations require physician review; advanced imaging generally requires a recent (within 60 days) detailed history/physical and appropriate laboratory studies (unless guideline-supported scheduled off-therapy surveillance); it applies to established patients and contrast is avoided when contraindicated.

"Very rare circumstances where tumor markers or obvious clinical symptoms show strong evidence suggesting recurrence and PET would replace conventional imaging modalities"