Pediatric Head Imaging Guidelines

This policy covers pediatric head imaging (including CT, MRI and nuclear medicine) for children with common head-related symptoms and symptom complexes addressed by the Clinical Decision Support Tool—examples include headache, head/face trauma, seizures/epilepsy, macrocephaly/microcephaly/hydrocephalus, craniofacial anomalies, pediatric stroke, demyelinating disease, sinus/ear disorders, pituitary dysfunction and similar conditions. Major limitations/requirements: advanced imaging generally requires prior pertinent clinical evaluation including a detailed neurologic exam and basic imaging (plain radiography or ultrasound) unless guideline-supported scheduled follow‑up; atypical or unaddressed presentations require physician/specialist review and authorization, screening asymptomatic individuals is not supported, and repeat studies are only allowed for progression, new findings, or when results will alter management.

"Ophthalmic ultrasound, diagnostic; quantitative A-scan only — 76511"