Pediatric Oncology Imaging Guidelines

This policy covers imaging services (plain radiography, ultrasound, CT, MRI, PET, and modality-specific guidance) for diagnosis, staging, surveillance, and screening in pediatric oncology across a wide range of childhood cancers and predisposition syndromes (e.g., leukemias, CNS tumors, lymphomas, neuroblastoma, renal/liver tumors, sarcomas, bone tumors, retinoblastoma, germ cell tumors, etc.). Major limitations/requirements include age-based guideline assignment (age at initial diagnosis determines pediatric vs adult protocols with AYA considerations), requirement for a recent (within 60 days) history/physical and appropriate labs before advanced imaging, justification of modality choice and minimization of radiation, and physician review for atypical or non‑covered presentations.

"Imaging for pediatric leukemias (PEDONC-3: Pediatric Leukemias)"

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