Pediatric Head Imaging Guidelines

This policy covers pediatric head imaging—advanced modalities including CT, MRI (including functional MRI), and related head/face/orbit studies—for children <18 years for a broad range of indications such as headaches, head and facial trauma, seizures/epilepsy, macrocephaly/microcephaly/hydrocephalus, craniosynostosis, Chiari/skull‑base malformations, stroke, vascular lesions, demyelinating and pituitary disorders, ENT issues, autism/behavioral concerns, and many other pediatric neurologic and head conditions. Major limitations require documented active clinical signs or symptoms (no routine screening of asymptomatic patients), generally a face‑to‑face evaluation within 60 days before advanced imaging unless scheduled per guideline, restriction on repeat or overlapping CPT codes unless progression or management impact is documented, and referral of atypical presentations for physician review; pediatric guidance applies only to patients <18 years.

"This tool addresses common symptoms and symptom complexes."