Pediatric Cardiac Imaging Guidelines

This policy covers pediatric cardiac imaging services — including echocardiography, cardiac MRI, CT, and nuclear studies — for evaluation and surveillance in general pediatric cardiology and a broad spectrum of congenital heart disease and related symptomatic presentations (e.g., ASD/PFO/PAPVR, VSD, AVSD, PDA, TOF, coronary anomalies). Major limitations/requirements: imaging generally requires a pertinent clinical evaluation (history/physical or meaningful telehealth contact plus review of diagnostic studies), atypical presentations require physician review, repeat studies are not medically necessary without documented progression or management impact, MRI often requires anesthesia in young children and is used when echo is inadequate while CT is primarily reserved if MR is contraindicated, and advanced imaging/echo are not indicated for asymptomatic screening or solely for ADHD medication initiation.

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