Oncology Imaging Guidelines

This policy covers oncology imaging — advanced diagnostic studies (eg, CT, MRI, PET) for evaluation, staging, surveillance, and monitoring of suspected or known malignancies across a broad range of tumor types (brain, lung, breast, GI, GU, sarcomas, etc.). Major limitations/requirements include a recent clinical evaluation (generally within 60 days), histologic confirmation and documented staging for medical necessity review (unless disease-specific guidance states otherwise), physician review for atypical presentations, restriction of routine/asymptomatic imaging, and specified timing intervals for on‑therapy and surveillance imaging (eg, brain MRI with and without contrast is preferred for suspected metastases).

"No documentation requirements are specified in the provided text."

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