Pediatric Abdomen Imaging Guidelines

This policy covers pediatric abdominal imaging (eg, ultrasound, CT, MRI, and select nuclear/PET studies) for evaluation of common symptoms and symptom complexes including generalized abdominal pain, right lower quadrant pain/appendicitis, flank pain/renal stones, UTI, acute gastroenteritis, hematuria, RUQ pathology, IBD, suspected abdominal abscess/sepsis, postoperative abdominal pain (within 60 days), abdominal mass, renovascular hypertension, liver and adrenal lesions, and other pediatric abdominal disorders. Major limitations/requirements: atypical presentations or indications not specifically addressed require physician review and/or consultation with the referring clinician; several codes (eg, certain PET codes, MRI abdomen with contrast CPT 74182) are rarely used in pediatrics and some unlisted codes are reserved for radiation planning, and this excerpt does not provide detailed coverage criteria, frequency limits, age restrictions, or other utilization rules.