Pediatric Musculoskeletal Imaging Guidelines

This policy covers pediatric musculoskeletal imaging—including extremity MRI (joint and non‑joint, with/without contrast, CPTs 73218–73223, 73718–73723), MRA, CT of the extremities, unlisted MRI for planning, and related advanced modalities—used to evaluate common pediatric musculoskeletal symptoms and conditions (e.g., acute/healing fracture, osteomyelitis, bone tumors). Major limitations/requirements: plain radiographs must be obtained and available before advanced imaging (unless guideline‑scheduled), repeat imaging requires evidence of progression or documentation of management impact, atypical presentations need physician review, contrast‑enhanced studies are rarely used for select CPTs, and certain PET codes are not applicable in pediatrics.

"CTA Upper Extremity | 73206"

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