Pediatric Cardiac Imaging Guidelines

This policy covers pediatric cardiac imaging—including echocardiography, cardiac MRI/MRA, CT/CCTA, and cardiac catheterization—for evaluation of congenital heart disease and common pediatric cardiac presentations such as heart murmur, chest pain, syncope, Kawasaki disease, and pediatric pulmonary hypertension. Major limitations: advanced imaging is approved only for patients with documented active cardiac signs/symptoms or as follow‑up to echocardiographic findings, generally requires a face‑to‑face evaluation within 60 days unless guideline‑scheduled, repeat studies require evidence of progression/new onset or documentation that results will affect management, asymptomatic screening is not supported, atypical presentations may need physician review, and modality/anesthesia use is guided (echo first, MRI preferred over CT when feasible; anesthesia planning for young children).

"Diagnostic Strategies:This tool addresses common symptoms and symptom complexes."