Pediatric Abdomen Imaging Guidelines

This policy covers diagnostic imaging of the pediatric abdomen (decision‑support guidance for modality selection) for common pediatric presentations such as generalized and focal abdominal pain (e.g., RLQ, RUQ, flank), suspected renal stones, UTI, gastroenteritis, hematuria, IBD, liver and adrenal lesions, postoperative pain, abdominal mass, and other pediatric‑specific abdominal disorders. Major limitations/requirements: atypical presentations require physician review; a pertinent clinical evaluation (history, exam, appropriate labs) and ultrasound are expected before advanced imaging, conservative therapy should be continued if the patient is improving, repeat or screening imaging is discouraged unless it will affect management, and certain nuclear medicine CPT codes are excluded or rarely used in pediatrics.

"PEDAB-30: Celiac Disease (Sprue)"

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