Pediatric Chest Imaging

This policy covers pediatric chest imaging studies (radiography, CT, MRI and related procedure codes such as CPT 71550–71552, 71270, and others) for evaluation of common pediatric chest symptoms and disorders including lymphadenopathy, mediastinal mass, hemoptysis, cystic fibrosis/bronchiectasis, bronchiolitis, pneumonia, asthma, tuberculosis/positive PPD, congenital lung disease, vascular malformations, pectus deformities, solitary pulmonary nodule, and related conditions. Major limitations/requirements: advanced imaging is intended for symptomatic patients <18 years with guideline-supported indications (adult guidelines apply ≥18), typically requires a recent (within 60 days) face‑to‑face evaluation, excludes asymptomatic screening and routine repeat studies without documented clinical change, and atypical presentations or certain modalities/codes (eg, many PET codes and some contrast studies) require physician review or are rarely used in pediatrics.

"Pediatric Chest Imaging Policy (clinical guidelines) — Diagnostic Strategies: This tool addresses common symptoms and symptom complexes."