Pediatric Abdomen Imaging Guidelines

This policy covers pediatric abdominal imaging (ultrasound, CT, MRI and selected nuclear/PET studies) for common pediatric abdominal symptoms and conditions including generalized or localized abdominal pain (RLQ, RUQ, flank), urinary tract infection/hematuria, renal stones, acute gastroenteritis, inflammatory bowel disease, suspected abdominal abscess, postoperative pain, constipation/diarrhea/IBS, abdominal masses, liver/adrenal lesions, renovascular hypertension and other typical pediatric abdominal pathologies. Imaging for atypical presentations requires physician review and possible specialist/PCP consultation; advanced imaging generally requires a recent (within 60 days) face‑to‑face evaluation with history, exam, labs and basic imaging, must be expected to affect management, and repeat or screening studies are not supported without evidence of new or progressive disease.

"PEDAB-27: Intussusception"