Pediatric Chest Imaging Guidelines

This policy covers pediatric chest imaging for evaluation of common pediatric chest symptoms and symptom complexes — including plain radiography, guideline-directed ultrasound (e.g., CPTs 76604, 76882, 76641/76642) and, when indicated, advanced imaging — for conditions such as lymphadenopathy, mediastinal mass, hemoptysis, cystic fibrosis/bronchiectasis, bronchiolitis, pneumonia, solitary pulmonary nodule, TB/positive PPD, asthma, pectus deformities, breast masses, vascular malformations and congenital chest diseases. Major limitations: advanced imaging (CT, MRI, nuclear medicine) is supported only for patients with documented active clinical signs/symptoms (not for routine screening of asymptomatic individuals), basic imaging or clinical evaluation should generally precede advanced studies, atypical or unaddressed presentations require physician review, and several PET and ventilation/perfusion CPTs are excluded or not used in pediatrics.

"Breast Masses (PEDCH-12)"