Pediatric Musculoskeletal Imaging Guidelines

This policy covers pediatric musculoskeletal imaging—guidance on use of plain radiography, ultrasound and advanced imaging (MRI, CT, nuclear medicine) and specific CPT procedures for common pediatric conditions such as fractures/dislocations, limping child, developmental dysplasia of the hip, SCFE, infection/osteomyelitis, suspected child abuse, soft‑tissue and bone masses, and other musculoskeletal symptom complexes in patients <18 years. Major limitations/requirements: MRI without contrast is preferred (contrast reserved for tumors, infection, post‑op, arthrography, JIA), plain x‑ray should precede advanced imaging, a recent (≤60 days) face‑to‑face evaluation is generally required before advanced studies, repeat imaging is limited unless progression or management impact is documented, atypical presentations require physician review, and anesthesia is often needed for young children (<7 years).

"This tool addresses common symptoms and symptom complexes."