Pediatric Head Imaging Guidelines

This policy covers pediatric head imaging procedures (CT, MRI, nuclear medicine and specialized/spectrum techniques) for evaluation of a wide range of pediatric head and facial conditions, including headache, head/face trauma, seizures/epilepsy, hydrocephalus/macrocephaly, craniosynostosis, stroke, intracranial vascular lesions and other neurologic, infectious, developmental and structural disorders. Advanced imaging is limited to patients with documented active clinical signs or symptoms, generally requires a recent (within 60 days) face‑to‑face evaluation with detailed history, neurologic exam and appropriate labs, is not supported for routine asymptomatic screening, repeat studies require evidence of progression or management impact, atypical presentations need physician review, and pediatric guidance applies to patients under 18 (with anesthesia commonly required for infants and many young children).

"Functional MRI Brain (CPT 70554 or CPT 70555)."