Pediatric Abdomen Imaging Guidelines

This policy covers pediatric abdominal imaging services (ultrasound, CT, MRI and related advanced imaging) for a wide range of pediatric abdominal symptoms and conditions — e.g., generalized abdominal pain, right lower quadrant pain, flank pain/renal stone, UTI, acute gastroenteritis, hematuria, inflammatory bowel disease, suspected abscess, postoperative pain, liver/adrenal/renal lesion characterization, renovascular hypertension, and many other pediatric abdominal indications. Major limitations/requirements: advanced imaging generally requires prior clinical evaluation (history, exam, labs, basic imaging), atypical presentations require physician review, imaging is not supported for asymptomatic screening or when results will not affect management, and repeat studies are limited to documented progression, new onset disease, or justification of impact on treatment.

"CT Abdomen without contrast | 74150"