Pediatric Abdomen Imaging Guidelines

This policy covers pediatric abdominal imaging and the use of the EviCore Clinical Decision Support Tool to determine medically necessary imaging for pediatric abdominal complaints, including generalized and focal abdominal pain (e.g., right lower/right upper quadrant, flank/renal stone), UTI, hematuria, acute gastroenteritis, inflammatory bowel disease, suspected abscess, postoperative pain within 60 days, abdominal mass, renovascular hypertension, and liver lesion/disease evaluation. Major limitations: the tool addresses common symptom complexes so atypical or unlisted presentations require physician review or specialist/PCP consultation; the content is proprietary for individual reference use only, and certain modalities/codes (e.g., MRI abdomen with contrast and several PET codes) are rarely used or restricted in pediatrics.

"Hemochromatosis (PEDAB-18)"

Sign up to see full coverage criteria, indications, and limitations.