Chest X-Ray Policy

This policy adopts a negative approach: chest radiographs are covered when they are clinically indicated to diagnose or guide treatment for cardiac/pulmonary disease, infections, inflammatory conditions, chest/upper abdominal trauma, malignancy, allergic/drug-related disease, or when symptomatic cardiopulmonary changes are present and documentation shows how results will affect care. Routine or preprocedural chest x-rays without signs or symptoms, and x-rays for minor trauma to the head, lower back, or extremities, are not reasonable and necessary and may be denied unless the clinical chart documents a specific, actionable reason and how the results will be used.

"Chest radiographs are covered when used to diagnose or guide treatment for pulmonary diseases."

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