Preface to the Imaging Guidelines

This policy covers appropriate use and review criteria for standard and advanced diagnostic imaging (plain film, CT, MRI, ultrasound) including problem‑directed evaluations, guideline‑supported surveillance, and clinical trial imaging requests. It applies to pediatric patients (<18) per the Pediatric Imaging Guidelines and adults (≥18) per the General Imaging Guidelines, and requires imaging to be based on the clinical presentation with adequate documentation—often including a recent (≤60 days) clinical evaluation or required x‑rays for spine/musculoskeletal cases—while state/federal mandates, payer/CMS policies, investigational status, or physician review may limit or override coverage.

"Imaging abdominal and pelvic viscera"

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