Pelvis Imaging Guidelines

Covers pelvic imaging services — including transvaginal and transabdominal ultrasound (and adjuncts like sonohysterography and Doppler), CT, MRI (including fetal MRI), and image‑guided procedures — for common pelvic symptoms and numerous gynecologic and urologic conditions (e.g., abnormal uterine bleeding, adnexal masses/ovarian cysts, endometriosis, PID, infertility, leiomyomata, pelvic pain, and fetal indications). Major limitations/requirements: atypical presentations require physician review and possible specialist/PCP consultation; advanced imaging requires a clinical evaluation within 60 days; transvaginal ultrasound is preferred (with pelvic US or MRI without contrast in pregnancy), CT use is limited, and 3‑D rendering, Doppler, and contrast studies are restricted to specified or equivocal scenarios.

"No alternative modality has demonstrated sufficient superiority to justify routine use (i."