Pediatric Spine Imaging Guidelines

This policy covers pediatric spine imaging—including plain radiography, spinal ultrasound, nuclear medicine planar and SPECT studies (CPTs noted) and advanced cross‑sectional imaging (CT, MRI)—for evaluation/localization of tumor, inflammatory processes, vascular flow/blood pool and other spinal pathology. It applies to pediatric patients (generally <18 years; patients ≥18 typically follow General Spine Imaging Guidelines), and limits advanced imaging to those with documented active signs/symptoms or guideline‑scheduled evaluations after a pertinent clinical assessment (history, neurologic exam, labs and basic imaging; telehealth contact acceptable); it does not support screening asymptomatic patients, has CPT‑specific single‑area vs whole‑body and single‑ vs multi‑day restrictions, and permits repeat studies only for progression, new disease, or when imaging will affect management.

"CPT 78804 is described as planar, whole body imaging requiring 2 or more days of imaging (i."