Oncology Imaging Guidelines

This policy covers oncology imaging—primarily CT (with MRI or bone scan when indicated)—for initial staging and surveillance across a wide range of cancers (e.g., CNS, head and neck, lung, breast, colorectal, prostate, sarcomas, thyroid, melanoma) in adult, pediatric and AYA patients with age-based guideline assignment. Major limitations/requirements include physician review for atypical presentations, a recent clinical evaluation within 60 days before advanced imaging (unless guideline-supported surveillance), typically a one-time approval for initial staging when initiating standard therapy, exclusion of routine monitoring for patients who decline standard oncologic therapy, and adherence to contrast precautions (avoid when contraindicated; manage iodinated allergy or renal insufficiency with alternatives or premedication protocols).

"This tool addresses common symptoms and symptom complexes."