Abdomen Imaging Guidelines

This policy covers abdominal imaging services—including CT, MRI (including MR enterography/enteroclysis and quantitative MRI), ultrasound (including contrast‑enhanced and retroperitoneal), and CT/MR/US‑guided abdominal procedures—for evaluation of common abdominal symptoms and symptom complexes (e.g., acute and chronic abdominal pain, RUQ/LUQ pain, epigastric pain, postoperative assessments, and pregnancy considerations). Major limitations require a current clinical evaluation within 60 days (or documented meaningful contact by an established provider) before advanced imaging, absence of appropriate history/physical/labs/non‑advanced imaging may preclude approval, atypical presentations require physician review, some studies are considered investigational, and payer‑specific policies may take precedence.

"Mesenteric/Colonic Ischemia (AB-6)"

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