Pediatric Abdomen Imaging Guidelines

This policy covers pediatric abdominal imaging (ultrasound, CT, MRI and related procedures) for common symptoms and symptom complexes — including generalized abdominal pain, right lower quadrant pain, flank pain/renal stones, UTI, gastroenteritis, hematuria, IBD, liver/adrenal lesions, suspected abscess, postoperative abdominal pain and many other pediatric-specific indications. Major limitations/requirements: applies to patients <18 years, generally requires a recent (within 60 days) face-to-face evaluation with history, physical exam, appropriate labs and basic imaging before advanced imaging; postoperative pain is covered only within 60 days of abdominal surgery; atypical presentations require physician review/consultation; and advanced imaging is only appropriate when it will affect patient management (not for routine screening).

"Abdominal Mass (PEDAB-13)"