Chest Imaging Guidelines

This policy covers chest imaging services using eviCore’s Clinical Decision Support tool for common chest symptoms and a wide range of thoracic conditions (e.g., lymphadenopathy, cough, non‑cardiac chest pain, dyspnea/shortness of breath, hemoptysis, bronchiectasis/bronchitis, COPD, interstitial disease, solitary and multiple pulmonary nodules, pneumonia/COVID‑19, pleural disease, asbestos exposure, sarcoid, and more). Major limitations/requirements: advanced imaging generally requires a recent clinical evaluation and a radiologist‑overread chest x‑ray (typically within 60 days) with comparison to prior films, atypical presentations need physician review, axillary adenopathy often warrants observation/biopsy rather than immediate advanced imaging, and specific CT/HRCT study selection and billing follow stated coding constraints.

"Pneumomediastinum; Subcutaneous Emphysema (CH-19."