Pediatric Cardiac Imaging Guidelines

This policy covers pediatric cardiac imaging modalities—including echocardiography, cardiac MRI (CPT 75557/75559/75561/75563), CT/CCTA, nuclear studies and related procedures—for children with common cardiac symptoms and conditions such as congenital heart disease, heart murmur, chest pain, syncope, Kawasaki disease, and pediatric pulmonary hypertension. Major limitations/requirements: a recent (within 60 days) face‑to‑face evaluation is required before advanced imaging unless guideline‑supported follow‑up, echocardiography is generally required before other modalities, imaging is not supported for asymptomatic screening, atypical presentations require physician review, anesthesia and gadolinium use have age/contraindication considerations, and repeat studies are only appropriate for new or progressive disease or when they will affect management.

"Echocardiography - Other Indications (PEDCD-8)"