Pediatric Cardiac Imaging Guidelines

This policy covers pediatric cardiac imaging—including transthoracic echocardiography and advanced modalities (cardiac MRI, CT, and nuclear medicine/SPECT/PET)—for evaluation and surveillance of congenital heart disease and other pediatric cardiac conditions (e.g., ASD, VSD, PDA, coronary anomalies, Kawasaki disease, MIS-C, and chest pain). Key limitations/requirements: it applies to the pediatric population and generally requires a recent clinical evaluation and review of prior studies before advanced imaging or echo (with specified exceptions), prioritizes echocardiography before other modalities, limits repeat studies unless progression or management impact is documented, reserves CT for when cardiac MR is contraindicated, often requires physician review for atypical presentations, and typically necessitates anesthesia for young children (<7 years).

"This tool addresses common symptoms and symptom complexes."