Pediatric Abdomen Imaging Guidelines

This policy covers diagnostic pediatric abdominal imaging (CT, MRI, ultrasound and nuclear medicine as appropriate) for patients <18 years, addressing common symptoms and specific conditions such as generalized abdominal pain, right lower quadrant pain, flank pain/renal stone, UTI, gastroenteritis, hematuria, IBD, liver and adrenal lesions, postoperative pain, abdominal mass, and renovascular hypertension. Major limitations/requirements: applies to patients <18 (with guideline-directed exceptions), atypical presentations require physician review and possible consultation with the referring clinician/PCP, a recent (≤60 days) face-to-face evaluation and basic studies are expected before advanced imaging, and imaging should be deferred if it will not affect management or while the patient is improving on conservative therapy.

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