Pediatric Chest Imaging

This policy covers pediatric chest imaging procedures—including radiography, CT, MRI (e.g., CPT 71550–71552) and related modalities—for evaluation of common pediatric symptoms and specific conditions such as lymphadenopathy, mediastinal mass, hemoptysis, cystic fibrosis/bronchiectasis, bronchiolitis, pneumonia, solitary pulmonary nodule, TB/positive PPD, asthma, pectus deformities, breast masses, vascular malformations, and congenital lung disease. It applies to patients <18 years, requires guideline-supported indications and a face-to-face clinical evaluation within 60 days before advanced imaging, mandates physician review for atypical or uncaptured presentations, and generally does not support screening/asymptomatic imaging, routine repeat studies, and certain rarely used or age-restricted codes (e.g., some MRI, CT, and PET codes).

"Pediatric Chest Imaging Guidelines"