Pediatric Chest Imaging

This policy covers pediatric chest imaging requests using the eviCore Clinical Decision Support Tool (eg, chest radiography, CT, MRI, PET and nuclear ventilation/perfusion studies) for diagnostic evaluation of common pediatric chest conditions. It applies to patients <18 years for presentations such as lymphadenopathy, mediastinal mass, hemoptysis, cystic fibrosis/bronchiectasis, bronchiolitis, pneumonia, asthma and related indications, but atypical presentations require physician review; many advanced imaging codes are rarely used, routine asymptomatic screening is not supported, repeat studies require evidence of change or impact on management, and a recent (≤60 days) face‑to‑face evaluation is generally required before advanced imaging.

"Pulmonary Ventilation (e."

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