Pediatric Head Imaging Guidelines

This policy covers pediatric head imaging—primarily advanced modalities such as CT, MRI, and nuclear medicine—for individuals <18 years to evaluate and follow a broad set of conditions including headache, head/face trauma, seizures/epilepsy, macrocephaly/microcephaly/hydrocephalus, craniosynostosis, Chiari and skull base malformations, intracranial vascular lesions and stroke, ENT/ear disorders, developmental and behavioral concerns, and other pediatric head disorders. Major limitations/requirements: advanced imaging generally requires a prior pertinent clinical evaluation (detailed history, physical and neurologic exam, basic imaging/labs or meaningful telehealth contact), atypical presentations need physician review, imaging is not indicated for asymptomatic screening, and routine repeat studies are only supported with evidence of progression or if results will change management.

"Megalencephalic leukoencephalopathy with subcortical cysts"