Chest Imaging Guidelines

This policy covers chest imaging studies—including chest x‑ray, chest CT (with/without contrast and HRCT), chest CTA/MRA, chest MRI and related ultrasound procedures—for evaluation of common chest symptoms and conditions such as cough, dyspnea/shortness of breath, hemoptysis, non‑cardiac chest pain, pulmonary nodules, interstitial lung disease, COPD, bronchiectasis, infections, lymphadenopathy and pleural disease. Major requirements include a current clinical evaluation and a recent chest x‑ray (generally within 60 days and over‑read by a radiologist) prior to advanced imaging with specified exceptions, physician review for atypical presentations, and modality‑specific limitations (e.g., CT without contrast generally reserved for contrast contraindication, nodule follow‑up or HRCT; certain combined CT protocols/HRCT slices are not separately billable).

"General guidelines for chest imaging (CH-1: General Guidelines)"