Pediatric Chest Imaging
EVICORE-PEDIATRIC_CHEST-IMAGING_GUIDELINES
This policy covers pediatric chest imaging services—including radiography, CT, MRI (CPT 71550/71551/71552), MRA/CTA and related modalities—for evaluation of a broad range of pediatric chest 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 disease. Major limitations require physician review for atypical presentations, prohibit routine advanced imaging for asymptomatic screening, and mandate documented prior clinical evaluation (history, physical, labs and basic imaging) before advanced imaging; some codes are rarely or not used in pediatrics and MRA/CTA are limited to non‑cardiac/non‑coronary indications.
"PET with concurrently acquired CT; limited area (this code rarely used in pediatrics) | 78814"