Pediatric Cardiac Imaging Guidelines

EviCore covers pediatric echocardiography as the primary modality and authorizes advanced imaging (cardiac MRI/MRA, CT/CCTA, nuclear studies, catheterization) only for specific indications (congenital heart disease, cardiomyopathy, coronary anomalies, MIS-C/Kawasaki, pulmonary hypertension, pre/post‑op mapping, etc.) and excludes routine asymptomatic screening, imaging to start ADHD meds, most isolated syncope evaluations, and other non‑indicated or investigational uses (e.g., fused SPECT/CT). Key requirements: a pertinent clinical evaluation and review of prior diagnostics (history/PE or meaningful tech contact, EKG/labs/prior imaging) or documented scheduled surveillance, plus documentation that prior TTE is inconclusive or that the repeat/advanced study will affect management, adherence to lesion‑specific surveillance intervals, and specified coding/measurement documentation (e.g., Z‑scores, EF, technical limitations).

"Prior to considering advanced imaging (CT, MR, Nuclear Medicine) or echocardiogram a pertinent clinical evaluation should be performed, including: a detailed history and physical exam or meaningful..."