Pelvis Imaging Guidelines

EviCore covers transvaginal and transabdominal pelvic ultrasound as the first‑line imaging for most female pelvic conditions (AUB, adnexal masses, endometriosis, PID, PCOS, infertility, IUD issues, fibroids, pelvic pain) and only supports MRI/CT/MRA/CTA selectively when ultrasound is equivocal, will change management or surgical planning (e.g., deep endometriosis, indeterminate adnexal masses); routine CT for pelvic anatomy, routine pelvimetry, routine interval MRI after embolization, routine 3D rendering for simple cysts, and use of gynecology CPTs in known pregnancy are excluded. Advanced imaging requires a recent clinical evaluation and usually prior ultrasound, documented history/physical and relevant labs (including pregnancy test in premenopausal patients), and adherence to one‑time imaging limits and condition‑specific prerequisites (e.g., tumor markers for adnexal masses, bimanual exam and STI testing for PID).

"Transvaginal ultrasound is the recommended modality for imaging; no alternative modality has demonstrated sufficient superiority to justify routine use, and Transvaginal (TV) ultrasound (CPT 76830)..."