Chest Imaging Guidelines

This policy covers chest imaging (plain radiography, ultrasound, CT including high‑resolution CT) for evaluation of common chest symptoms and diagnoses—such as lymphadenopathy, cough, non‑cardiac chest pain, dyspnea/shortness of breath, hemoptysis, bronchiectasis/COPD, interstitial lung disease, pneumonia/COVID‑19, pleural disease, solitary pulmonary nodules, and mediastinal masses. Major limitations: advanced imaging generally requires a prior pertinent clinical evaluation, basic imaging and labs and often a recent chest x‑ray (typically within 60 days) reviewed by a radiologist; atypical presentations require physician review, and specific CPT coding/technique restrictions apply (e.g., CT chest without and with contrast is rarely needed versus contrast only and HRCT slices are not separately billable).

"CH-1."

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