Pediatric Cardiac Imaging Guidelines

This policy covers pediatric cardiac imaging services—including echocardiography, cardiac MRI, CT/CCTA, cardiac catheterization and related procedures—used to evaluate congenital and acquired pediatric heart disease such as congenital heart defects, heart murmur, chest pain, syncope, Kawasaki disease, MIS‑C, and pediatric pulmonary hypertension. Major requirements/limitations include a recent pertinent clinical evaluation before advanced imaging or echo (atypical presentations require physician review), imaging and repeat studies are authorized only for listed indications (CT reserved primarily when MR is contraindicated), and anesthesia/logistical considerations apply for young or developmentally delayed children.

"This tool addresses common symptoms and symptom complexes."

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