Pelvis Imaging Guidelines

This policy covers pelvis imaging (ultrasound including transvaginal ultrasound, pelvic MRI and fetal MRI, CT when appropriate, and image-guided procedures) for a wide range of pelvic and related conditions including abnormal uterine bleeding, amenorrhea, adnexal masses/ovarian cysts, endometriosis, PID, leiomyomata, IUD/tubal issues, male pelvic and scrotal disorders, fetal indications, and many others. Major limitations/requirements include a documented clinical evaluation within 60 days (history/physical, relevant labs and/or non‑advanced imaging) before advanced imaging is considered, preference for transvaginal ultrasound in adult sexually active females (pelvic ultrasound as complementary or only substitute in pediatric/non–sexually active patients), avoidance of contrast in pregnancy (use US or MRI without contrast), and recognition that CT is limited for pelvic soft‑tissue assessment and contraindicated with contrast allergy; atypical presentations require physician review.