Preface to the Imaging Guidelines

This policy provides eviCore’s evidence‑based clinical review criteria for selecting appropriate advanced imaging and related procedures (e.g., NM, US, CT, MRI, PET, radiation oncology, sleep studies, GI endoscopy, cardiac and spine interventions) for common symptoms and symptom complexes in adults (≥18 per General Imaging Guidelines) and children (<18 per Pediatric Imaging Guidelines), applying anatomic sex‑assigned‑at‑birth considerations where relevant. It limits automatic approval for atypical presentations (which require physician review), is proprietary and intended for individual clinician use to determine medical necessity, and is subject to Health Plan and CMS coverage rules (CMS/CED supersedes these guidelines for Medicare), with investigational or nonstandard studies excluded or requiring special review.

"This tool addresses common symptoms and symptom complexes."