Pediatric Chest Imaging Guidelines

This policy covers pediatric chest imaging—including chest radiography, CT and MRI modalities (e.g., CPT 71550/71551/71552 and specified chest CTA/MRA codes)—for children <18 presenting with common chest symptoms and conditions such as lymphadenopathy, mediastinal mass, hemoptysis, cystic fibrosis/bronchiectasis, bronchiolitis, pneumonia, solitary pulmonary nodule, tuberculosis/positive PPD, asthma, pectus deformities, breast masses, and vascular malformations. Major limitations/requirements: applies to patients <18 (adult chest guidelines for ≥18), generally requires a recent (within 60 days) face‑to‑face evaluation for advanced imaging, physician review for atypical presentations, avoidance of screening asymptomatic or unnecessary repeat studies, and specific MRI constraints (gadolinium contraindications, implanted device exclusions, and frequent anesthesia needs for young children), with some CPT codes rarely used or not appropriate in pediatrics.

"PET Imaging: whole body (CPT 78813)"