Pediatric Spine Imaging Guidelines

This policy covers pediatric spine imaging, including radiopharmaceutical localization (planar, SPECT, and SPECT/CT) and related nuclear medicine procedures used to evaluate spinal tumors, inflammatory processes, and radiotracer distribution. It applies to children with back/neck pain, trauma, congenital spine disorders (scoliosis, kyphosis, spinal dysraphism/tethered cord), myelopathy and other pediatric spine conditions, and requires physician review for atypical presentations; many procedures are limited to single-area/single-day protocols (SPECT/CT single area), certain PET codes are not typically used in pediatrics, and multi-area or multi-day imaging is generally excluded.

"This tool addresses common symptoms and symptom complexes."

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