Chest Imaging Guidelines

This policy covers chest imaging (plain radiography, chest ultrasound, chest CT including contrast and non‑contrast, and low‑dose CT screening) for individuals presenting with common chest‑related symptoms and findings per the eviCore Clinical Decision Support Tool — examples include cough, dyspnea/shortness of breath, hemoptysis, pleural effusion, pneumothorax, solitary or multiple pulmonary nodules, bronchiectasis, interstitial lung disease, pneumonia, asbestos exposure, sarcoid, and lymphadenopathy. Major requirements and limitations include a clinical evaluation within 60 days and generally a recent (≤60 days) radiologist‑overread chest x‑ray prior to advanced imaging (exceptions: supraclavicular lymphadenopathy, known bronchiectasis, suspected ILD, positive PPD/tuberculosis, suspected pulmonary AVM); atypical presentations require physician review, CT with contrast is limited to specific intrathoracic evaluations (non‑contrast CT mainly for contrast contraindication or nodule follow‑up), and low‑dose CT screening is limited to asymptomatic 55–80 year olds with ≥30 pack‑year smoking history who are surgical candidates and have not had LDCT in the past 12 months.