Pediatric Cardiac Imaging Guidelines

This policy covers pediatric cardiac imaging services—echocardiography, cardiac MRI, CT/CCTA, and cardiac catheterization—per the Pediatric Cardiac Imaging Guidelines. It applies to patients <18 years, particularly those with congenital or acquired pediatric heart disease, murmurs, chest pain, syncope, Kawasaki disease, pulmonary hypertension, or for guideline‑supported follow‑up/echocardiogram findings, and requires documented active cardiac signs/symptoms or scheduled follow‑up; advanced imaging generally requires a recent (within 60 days) face‑to‑face evaluation and repeat studies are limited to evidence of progression, new onset, or documentation that results will affect management. Screening of asymptomatic patients is not supported, atypical presentations require physician review, adult (≥18) cardiac guidelines apply for older patients, and MRI in young children frequently requires anesthesia.

"This tool addresses common symptoms and symptom complexes."