Pediatric Cardiac Imaging Guidelines

The eviCore Pediatric Cardiac Imaging Guidelines cover TTE as the primary test and authorize advanced cardiac imaging (cardiac MRI, CT/CCTA, MRA, nuclear studies) for symptomatic children, lesion‑specific surveillance, inconclusive TTE/MRI, and defined indications (congenital heart disease, cardiomyopathies including DMD/iron overload, Kawasaki disease, MIS‑C follow‑up, pre‑procedural coronary mapping), while excluding routine screening of asymptomatic children (including for ADHD medication starts), many unnecessary repeat studies, and certain investigational combinations (e.g., SPECT/CT fusion). Authorization requires a documented baseline clinical evaluation (detailed history and physical or meaningful tele‑contact) and prior study review, documentation that imaging will affect management (and that a recent TTE/MRI was inconclusive for advanced imaging), and adherence to modality‑ and lesion‑specific frequency and coding requirements.

"Echocardiography (CPT 93306) is indicated for initial assessment for suspected or known Kawasaki disease."