Preface to the Imaging Guidelines

This policy provides evidence-based guidelines for advanced diagnostic imaging and related procedures — including nuclear medicine, ultrasound, CT, MRI, PET, radiation oncology, sleep studies, gastrointestinal endoscopy, and various cardiac, musculoskeletal and spine interventions — for evaluation of common symptoms and symptom complexes. Applicability includes general symptomatic patients and Medicare/Medicare Advantage enrollees (CMS policies take precedence), and coverage is contingent on health plan rules, adequate recent clinical information, exclusion of investigational or data‑collection‑only studies, with atypical presentations requiring physician review and clinician judgment able to override the guidelines.

"The guidelines undergo a formal review annually."

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