Pediatric Oncology Imaging Guidelines

This policy covers diagnostic imaging services for pediatric oncology patients, addressing indications across a broad range of childhood cancers and conditions (e.g., general pediatric oncology guidance, cancer predisposition screening, leukemias, CNS tumors, lymphomas, neuroblastoma, renal, soft tissue, bone, germ cell, liver, retinoblastoma, and many others). Major limitations/requirements: scope is limited to pediatric presentations with atypical or uncommon cases requiring physician review; advanced imaging generally requires a recent (within 60 days) history/physical and laboratory studies or guideline-supported surveillance, routine surveillance imaging without localizing signs or corroborating radiography/ultrasound is not supported, screening with advanced imaging is restricted to PEDONC‑2 conditions, and studies must minimize radiation and follow age-based technique guidance (pediatric vs adult based on age at initial diagnosis).

"Cardiac rhabdomyosarcoma (associated malignancy in TSC) — screening/monitoring indication"