Pediatric Abdomen Imaging Guidelines

This policy covers pediatric abdominal imaging studies (ultrasound, CT, MRI, image-guided procedures and related PET codes) for evaluation of common abdominal symptoms and symptom complexes including generalized abdominal pain, RLQ pain, flank/renal colic, UTI, gastroenteritis, hematuria, RUQ pain, inflammatory bowel disease, suspected abscess, postoperative pain (within 60 days), constipation/diarrhea, abdominal mass, liver/adrenal lesions, and other pediatric abdominal conditions. Major limitations: it applies only to pediatric patients and typical/common presentations—atypical or unaddressed presentations require physician review and possible consultation; several modalities/CPT codes (e.g., MRI abdomen with contrast, certain PET codes, unlisted CT/MRI) are noted as rarely used or limited to specific purposes (radiation planning, ablation, guidance), and the excerpt provides no explicit frequency, age cutoffs, or other coverage limits.

"Vomiting infant"