Chest Imaging Guidelines

This policy covers chest imaging modalities (plain radiography, ultrasound, CT including HRCT, and occasional MRI) for common thoracic symptoms and findings such as cough, dyspnea, chest pain, hemoptysis, lymphadenopathy, pulmonary nodules, bronchiectasis, COPD, interstitial lung disease, pneumonia, asbestos exposure, sarcoidosis, and related indications. Major requirements/limitations include physician review for atypical presentations, a clinical evaluation within 60 days (or documented other meaningful contact for established patients), a recent chest x‑ray over-read prior to advanced imaging, appropriate preceding labs/non‑advanced imaging, and adherence to specified CPT coding and protocol restrictions (with MRI infrequently indicated).

"CH-5: Dyspnea/Shortness of Breath (general heading)"

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