CurrentColorado Rocky Mountain Health PlansPolicy CSRAD021OH.E
Pediatric and Special Populations Oncology Imaging Guidelines (For Ohio Only)
Clinical guidelines governing advanced imaging and related procedures for pediatric and special oncology populations in Ohio; applies to providers and requests for imaging coverage determination under the payer's Ohio policy.
Policy Summary
PayerColorado Rocky Mountain Health Plans
PolicyPediatric and Special Populations Oncology Imaging Guidelines (For Ohio Only)
Policy CodePolicy CSRAD021OH.E
Change TypeTechnical / No material change
Effective DateFeb 3, 2026
Next Review Date
Key ActionSubmit adequate clinical documentation and, when required, obtain prior authorization per Ohio Administrative Code 5160-1-01 to establish medical necessity for advanced imaging.
No material clinical or coverage changes in this revision.
V1.0.2026guideline version
Ohiostate
Evidence-basedevidence
variedfrequency guidance
15+sections (partial)
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Coverage criteria and condition-specific imaging rules
General medical necessity criteria
Covered when ALL of the following are met (general requirements):
General clinical evaluation: Pertinent clinical evaluation since onset or change in symptoms including detailed history, physical examination, appropriate laboratory studies, and appropriate prior imaging studies
Condition-specific guideline sections may require additional information (e.g., spine x-rays).
Timing of imaging: Advanced imaging or other designated procedures are ordered only after a pertinent clinical evaluation by the treating physician (face-to-face or other meaningful technological contact), except for guideline-supported scheduled surveillance
Some conditions require face-to-face evaluation per condition-specific guidance.
Documentation submission: Submission of medical records pertinent to the requested imaging or designated procedure is required to establish medical necessity
Include prior imaging, labs, and treatment history; spine/musculoskeletal requests should include x-rays from onset/change of episode.
Prefatory Medical Necessity Criteria
Covered when ALL of the following are met
Clinical evaluation: Imaging is supported when ordered based on the individual's clinical presentation and after a pertinent clinical evaluation (history, exam, labs, prior imaging) has been submitted.
Condition-specific sections may require additional documentation.
Age-based guideline routing: Individuals ≤18 years follow Pediatric Imaging Guidelines when applicable; otherwise General Imaging Guidelines apply.
Modality appropriateness: Select modality and contrast level based on the clinical question and condition-specific guidance; prefer less invasive or lower-risk modalities when adequate.
Examples: ultrasound for soft-tissue or surveillance where appropriate; CT for urgent thoracic/airway/trauma; MRI for CNS and musculoskeletal characterization.
Contrast and safety considerations:
Acceptable Indications for CPT 76376/76377
CPT 76377 or CPT 76376 can be considered in the following clinical scenarios
3D rendering acceptable scenarios: Use of CPT 76376 or CPT 76377 is appropriate for bony conditions (congenital skull abnormalities in newborns/infants/toddlers for pre-op planning; complex fractures/dislocations; spine/pelvic/intra-articular fractures when conventional imaging is insufficient), complex facial fractures, pre-operative planning for other complex surgical cases, cerebral angiography, select pelvic/uterine indications when ultrasound is equivocal, hydrosalpinx/peritoneal cysts when US indeterminate, lost IUD when US inconclusive, uterine anomalies, infertility workup, CT urogram, and MRCP as listed in policy
Scenarios listed verbatim from guideline examples.
Imaging Guidance Billing and Appropriateness Criteria
Imaging guidance codes include all imaging necessary to guide needles/catheters and have specific billing rules:
Guidance billing rules: Imaging guidance procedure codes (CT, MR, US guidance codes) include the imaging necessary to guide percutaneous procedures and should be used to report guidance; do not routinely bill a separate diagnostic imaging code in conjunction with a guidance code; only one unit of a guidance code is reportable per encounter; CPT 77013 is for non-bone ablation procedures and CPT 20982 covers CT guidance for bone tumor ablation; MR guidance codes are not appropriate for MRI-guided breast biopsy (use 19085/19086).
Billing and appropriateness rules summarized from table and guidance.
Unlisted Procedure Medical Necessity Criteria
Use of unlisted CT/MR/nuclear medicine procedure codes
When to use unlisted codes: Report CPT 76497 (unlisted CT), CPT 76498 (unlisted MR), or CPT 78999 (unlisted diagnostic nuclear medicine) when no appropriate anatomic-site specific CPT code exists; a Category III code must be used instead of an unlisted code when available; CPT 76497/76498 may be appropriate for neurosurgical navigation/Stealth/Brain Lab imaging, custom joint arthroplasty planning, or procedures requiring thinner cuts or different positional acquisition for surgical planning.
Follow Management of Unlisted Codes process for submission and justification.
Unlisted procedure usage
Unlisted CT/MR/nuclear codes may be medically necessary in specific clinical scenarios when no anatomic-specific code exists.
uses: Report CPT 76497/76498/78999 when the diagnostic or interventional CT, MR, or nuclear procedure performed cannot be reported with an anatomic-site specific CPT code; use a Category III code instead if available
Provide clinical rationale and operative/surgical planning documentation when applicable.
Limited CT (CPT 76380) coverage stance
CPT 76380 describes limited or follow-up CT and has restricted coverage.
limited_ct: CPT 76380 is appropriate for limited or follow-up CT examinations in which the work of a full diagnostic CT code is not performed (examples: limited sinus CT, limited slices through a known pulmonary nodule, limited slices for non-healing fracture assessment); it is not medically necessary for treatment planning purposes and should not be used to bill 'extra slices' in conjunction with other diagnostic CT codes.
Ensure the limited nature and clinical justification are documented.
Whole-body imaging stance
Whole-body imaging (CT, MRI) coverage varies by indication and is generally limited.
whole_body_ct: Whole-body CT or 'LifeScan' for screening of asymptomatic individuals is not a covered benefit due to radiation risk and lack of demonstrated screening benefit; limited exception for whole-body low-dose skeletal CT in multiple myeloma staging per oncology guideline.
Do not use WB CT for routine asymptomatic screening.
whole_body_mri: Whole-body MRI (WBMRI) is generally not supported due to lack of standardization and outcome evidence, but interval WBMRI is recommended for screening in specified cancer predisposition syndromes (e.g., LFS, NF1/NF2, RTPS, HPP, CMMRD, Infantile Myofibromatosis, Bloom Syndrome); report WBMRI using CPT 76498 when indicated.
Provide syndrome-specific documentation per guideline when requesting annual or frequent WBMRI.
PET/MRI coverage criteria
PET/MRI is generally not supported but may be medically necessary under defined conditions.
pet_mri_criteria: PET/MRI is medically necessary only when EITHER condition-specific PET/MRI guidelines apply OR when ALL of the following are met: the individual meets guideline criteria for PET/CT; PET/CT is not available at the treating institution; and the provider requests PET/MRI in lieu of PET/CT. When allowed, report PET/MRI using CPT 78813 (PET whole-body) plus CPT 76498 (MRI unlisted); other reporting methods are inappropriate.
Diagnostic MRI codes may be medically necessary concurrently when clinically appropriate.
General Advanced Imaging Medical Necessity
Covered when ALL of the following are met
Pre-evaluation: A relevant clinical evaluation or meaningful contact (history/physical, labs, biopsy results, or prior imaging) should be performed and documented prior to advanced imaging unless guideline-supported scheduled surveillance applies.
Histologic confirmation is generally required for malignancy imaging reviews unless otherwise specified.
Symptom/Sign Requirement: Advanced imaging for asymptomatic individuals is generally not medically necessary without signs or symptoms of systemic involvement unless specified in diagnosis-specific guidelines.
Conventional imaging should be reviewed and considered before advanced modalities.
Repeat Imaging: Repeat imaging is not generally medically necessary unless there is evidence of disease progression, recurrence, or the repeat study will affect clinical management; treatment response imaging is generally appropriate after every 2 cycles of therapy unless otherwise specified.
Timing examples: ~6 weeks for solid tumor cycles, ~8–12 weeks for CNS tumors.
Pediatric Imaging by Phase of Care
Phase-specific rules apply as follows
Suspected/Initial Staging: Imaging from initial suspicion until treatment initiation; CT chest prior to anesthesia for biopsy/resection and CTs of other involved areas are generally indicated and should be performed concurrently; metastatic CNS and nuclear imaging generally deferred until after histologic diagnosis unless otherwise specified.
See diagnosis-specific sections for exceptions.
Treatment Response: Imaging during active treatment is medically necessary generally after every 2 cycles (approximately ~6 weeks for solid tumors; ~8–12 weeks for CNS tumors) unless otherwise stated in condition-specific guidance.
Frequency may vary by tumor type and therapy phase.
Surveillance: Imaging for asymptomatic or chronically stable individuals not receiving active treatment; PET is not medically necessary for surveillance unless specified in diagnosis-specific sections.
Surveillance scheduling and intervals are defined in condition-specific guidance.
PET/CT and Nuclear Medicine Indications and Exclusions
PET/CT may be indicated in select scenarios; exclusions listed.
Indications for PET/CT: PET/CT may be considered when conventional imaging (CT, MRI, or bone scan) is inconclusive or negative with continued suspicion for recurrence, or to select a favorable biopsy site after nondiagnostic prior biopsy.
Delay PET/CT for at least 12 weeks after radiation unless required sooner for imminent surgery.
PET/CT Exclusions: PET/CT is not medically necessary for infection/inflammation/trauma/post-op healing, when performed concomitantly with separate diagnostic CTs, for conclusive distant metastatic disease on conventional imaging, for CNS metastatic disease, for lesions <8 mm, for routine surveillance, or for serial monitoring of FDG avidity until resolution.lesion_size <8 mm
PET/MRI and nonstandard radiotracers are generally not supported; see tracer-specific guidance.
Cardiac Function Assessment Criteria
Cardiac imaging to assess cardiotoxicity during active pediatric oncology treatment
When Echocardiography is Preferred: Echocardiography (CPT 93306/93307/93308) is the medically necessary study for evaluation of cardiac function prior to cardiotoxic chemotherapy and for monitoring during active therapy or at end of therapy based on cumulative therapy, age/gender, prior echo results, or new/worsening cardiac signs.
Clinical judgment guides monitoring intervals.
When MUGA is Indicated: MUGA (CPT 78472) is medically necessary when echocardiography yields a borderline shortening fraction (<30%) and additional left ventricular function data are required for chemotherapy decisions, or when echocardiographic windows are suboptimal.shortening_fraction <30%
PET imaging — general medical necessity
PET is medically necessary when specific conditions are met:
PET medical necessity: All of the following must apply: (1) Conventional imaging (CT, MRI, US, plain film) reveals findings that are equivocal or suspicious; (2) No other specific metabolic imaging (e.g., MIBG, octreotide) is appropriate for the cancer type; (3) The submitted clinical information describes a specific decision that will be made based on the PET results.
PET is not reliable for lesions <8 mm and PET/CT is the preferred PET modality (CPT 78815/78816). Once PET is documented negative or all PET-avid disease resected, PET is not medically necessary for routine surveillance unless new suspicious conventional imaging exists.
PET/MRI medical necessity
PET/MRI is medically necessary only in select circumstances:
PET/MRI criteria: PET/MRI may be medically necessary if EITHER the individual meets condition-specific PET/MRI guidelines OR ALL of the following are met: the individual meets guideline criteria for PET/CT; PET/CT is not available at the treating institution; the provider requests PET/MRI in lieu of PET/CT. When allowed, PET/MRI must be reported using CPT 78813 + CPT 76498.
Provide documentation that PET/CT is unavailable and clinical justification per prior auth expectations.
MRI instead of CT to avoid radiation in young children
Substitution of MRI for CT to avoid radiation is medically necessary if ALL of the following apply:
MRI substitution: (1) The individual is a young child and the ordering physician documents that MRI is requested to avoid ionizing radiation; (2) Disease-specific guidance does not list CT as superior to MRI for the current disease and time point; (3) The request is for a body area other than chest (MRI is substantially inferior to CT for small pulmonary metastases).
Ordering clinician must document rationale; clinical judgment may warrant variance.
Imaging for suspected infection during active chemotherapy
Imaging to evaluate infectious complications during active chemotherapy is approved when:
Infection imaging indications: (1) Individual has absolute neutrophil count (ANC) <500; OR (2) Inconclusive chest x-ray or ultrasound findings at any ANC during active treatment; OR (3) Individuals receiving supplemental IVIG for therapy-induced hypogammaglobulinemia should be treated similarly to individuals with ANC <500.ANC <500
Frequent CT may be indicated for known invasive fungal infections and should be approved as requested when acute clinical decisions depend on imaging.
Surveillance and recurrence imaging
Definitions and key rules:
Surveillance imaging is for asymptomatic or chronically stable individuals not receiving active treatment; PET is not medically necessary for surveillance unless specifically stated in diagnosis-specific sections.
Refer to condition-specific surveillance schedules for frequency and modality.
Recurrence imaging is for cases where recurrence/progression is suspected or documented by clinical signs, labs, or basic imaging; studies recommended for initial staging should be approved for recurrence and follow appropriate modality-specific timing.
During active treatment for recurrent disease, continue modality consistency for monitoring when possible.
MRI in pediatric patients and anesthesia considerations
MRI use and anesthesia planning considerations:
MRI contrast and anesthesia: When MRI is performed under anesthesia plan to obtain non-contrast and contrast sequences in the same session unless GBCA is contraindicated; limit repetitive GBCA use to situations where contrast alters management; obtain all necessary body areas concurrently to avoid repeat anesthesia exposures.
If clinician documents GBCA concern a non-contrast exam may be approved.
Li-Fraumeni surveillance
Li-Fraumeni Syndrome — surveillance considered medically necessary when specified:
LFS annual and infant imaging: ALL of the following: annual MRI Brain without and with contrast (CPT 70553) AND annual whole-body MRI (CPT 76498); abdominal and pelvic ultrasound every 3 months from birth (CPT 76700 and 76856); beginning at age 20, annual breast MRI (CPT 77049) alternating every 6 months with breast ultrasound in addition to the annual MRI studies.
Targeted MRI of symptomatic sites is medically necessary when symptoms suggest malignancy.
NF1/NF2 surveillance
Neurofibromatosis 1 and 2 — surveillance considered medically necessary when specified:
NF1 indications: For NF1: one-time diagnostic MRI Brain and Orbits without and with contrast for clarification; annual MRI Brain beginning at age 10; MRI Spine without and with contrast every 3 years for those without spinal tumor history and annually for those with prior spinal tumors; MRI of known symptomatic body areas and preoperative planning as indicated. PET/CT may be considered for suspected malignant transformation when MRI inconclusive.
Surveillance WBMRI in late adolescence may be considered per AACR guidance for tumor burden assessment.
NF2 indications: For NF2: follow NF2-specific recommendations including annual brain MRI for vestibular schwannoma surveillance and MRI spine per indicated schedule; manage meningioma/ependymoma per respective tumor guidelines.
Renal/adrenal surveillance in BWS/DDS/WAGR
Beckwith-Wiedemann, Denys-Drash, and WAGR — abdominal surveillance in early childhood:
BWS routine screening: ALL of the following: abdominal ultrasound (CPT 76700) every 3 months from birth to 8 years; for purely cystic adrenal masses continue ultrasound every 3 months without additional advanced imaging; for solid or mixed adrenal masses follow age- and size-based imaging (MIBG and CT/MRI) as specified prior to biopsy/resection.birth_to_8_years_q3_months
If no evidence of malignancy after workup, repeat abdominal ultrasound every 6 weeks for 2 years per guideline.
DDS and WAGR screening: ALL of the following: abdominal ultrasound (CPT 76700) every 3 months from birth to 8 years; known renal tumors are managed under pediatric renal tumor guidance.birth_to_8_years_q3_months
WAGR (PEDONC-2.6)
Imaging surveillance for WAGR
WAGR surveillance: All individuals from birth to the 8th birthday: abdominal ultrasound (CPT 76700) every 3 months.age_birth_to_8_years
Known renal tumors follow Pediatric Renal Tumors guidance (PEDONC-7).
FAP and related conditions (PEDONC-2.7)
Imaging surveillance for FAP and related conditions
FAP early childhood abdominal US: All individuals from birth to the 6th birthday: abdominal ultrasound (CPT 76700) every 3 months.birth_to_6_years_q3_months
Family history of desmoid tumors: abdominal US annually for life after age 6.
FAP adolescent/adult surveillance: Beginning at age 12: annual thyroid ultrasound (CPT 76536). Beginning at age 30: annual pelvic ultrasound (CPT 76856). For Spigelman Stage III/IV or planned duodenectomy: MR enterography (MRI abdomen CPT 74183 and MRI pelvis CPT 72197).age_12_and_age_30
MEN1 and MEN2 (PEDONC-2.8)
Imaging surveillance for Multiple Endocrine Neoplasia (MEN)
MEN1 surveillance: Beginning at age 5: annual MRI Brain (70553) and MRI Abdomen (74183) or CT Abdomen with contrast (74160) or ultrasound (76700); annual octreotide study as indicated. Beginning at age 15: annual MRI Chest (71552) or CT chest with contrast (71260).age_5_and_15
Known thyroid cancer or pheochromocytoma managed per disease-specific guidance.
MEN2a/2b surveillance: Beginning at age 5: MRI Abdomen (74183) every 3 years; if elevated catecholamines or inconclusive adrenal mass on MRI consider octreotide or adrenal nuclear imaging (78075).age_5
Tuberous Sclerosis Complex (PEDONC-2.9)
Imaging surveillance for Tuberous Sclerosis Complex (TSC)
TSC brain surveillance: At suspected diagnosis until age 25: annual brain MRI without and with contrast (70553).diagnosis_to_age_25
SEGA tumors follow LGG guidance.
TSC abdominal surveillance at diagnosis: At diagnosis: single baseline MRI abdomen without and with contrast (74183). If no renal lesions on baseline MRI, perform annual renal ultrasound through age 11; at age 12 (or 10 years earlier than youngest affected family member) switch to annual abdominal MRI (74183). For documented renal lesions, perform annual abdominal MRI.age_based
Abdominal MRI is medically necessary for women of childbearing age planning pregnancy.
TSC chest surveillance: Beginning at age 18: CT chest without contrast (71250) every 5 years; if baseline CT chest abnormal then annually; new pulmonary symptoms or worsening PFTs warrant CT chest without contrast.
Von Hippel-Lindau (PEDONC-2.10)
Imaging surveillance for Von Hippel-Lindau (VHL)
VHL CNS surveillance: Beginning at age 11: MRI Brain (70553) and MRI Spine (72156/72157/72158) every 2 years; individuals with known unresected hemangioblastoma: MRI brain and spine annually.age_11_or_known_hemangioblastoma
One-time MRI brain may be done for frequent ear infections prior to age 8.
VHL abdominal surveillance: Beginning at age 5: annual abdominal ultrasound (76700). Beginning at age 15: MRI abdomen (74183) every 2 years; if elevated catecholamines or inconclusive adrenal mass consider octreotide or adrenal nuclear imaging.age_5_and_15
Rhabdoid Tumor Predisposition (PEDONC-2.11)
Imaging surveillance for Rhabdoid Tumor Predisposition Syndrome
Baseline WBMRI: All individuals at diagnosis (as early as birth if requested): whole-body MRI (CPT 76498).at_diagnosis
Baseline WBMRI guides targeted imaging.
Infant intensive US screening: From birth to 6 months: monthly ALL of the following: US head (76506), US abdomen (76700), US pelvis (76856), US neck (76536); MRI with and without contrast of areas of concern on baseline WBMRI.birth_to_6_months_monthly
Inconclusive US -> MRI of that site replaces US for remainder of planned screening.
Early childhood multi-modality screening: From 7 months to 5 years: every 3 months ALL of the following: US abdomen (76700), US pelvis (76856), US neck (76536), MRI brain (70553), MRI spine (72156/72157/72158) without and with contrast, and MRI with and without contrast of areas of concern on baseline WBMRI.
RTPS surveillance
Rhabdoid Tumor Predisposition Syndrome (RTPS) surveillance — Covered when ALL of the following are met
Baseline and age-based surveillance: At diagnosis (as early as birth if requested): Whole-body MRI (CPT 76498).
Baseline WBMRI required.
Birth to 6 months surveillance: From birth to 6 months: ALL of the following monthly: US Head (76506), US Abdomen (76700), US Pelvis (76856), US Neck (76536); MRI with and without contrast of areas of concern found on baseline WBMRI.monthly
If ultrasound inconclusive, MRI of that site replaces US for remainder of planned screening.
7 months to 5 years surveillance: Age 7 months to 5 years: ALL of the following every 3 months: US Abdomen (76700), US Pelvis (76856), US Neck (76536), MRI Brain (70553), MRI Spine (72156/72157/72158) without and with contrast; MRI with and without contrast of areas of concern on baseline WBMRI.every 3 months
Familial Retinoblastoma surveillance
Familial Retinoblastoma surveillance — Covered when ONE of the following applies
Prefer US/MRI over CT or nuclear imaging to avoid radiation.
Inconclusive EUA or new symptoms: Inconclusive examination under anesthesia (EUA) findings or new ocular symptoms: US Orbits (76512/76510/76511) or MRI Orbits (70543).as indicated
These studies should be used in lieu of CT/nuclear imaging when possible.
HPP surveillance
Hereditary Paraganglioma-Pheochromocytoma (HPP) surveillance — Covered when ALL of the following are met
Routine imaging starting age 6: All individuals with SDHx, MAX, or TMEM127 mutations beginning at age 6: every 2 years perform either whole-body MRI (76498) OR compartmental MRI (Neck 70543, Chest 71552, Abdomen 74183, Pelvis 72197) without and with contrast.every 2 years
If MRI cannot be performed, CT Neck/Chest/Abdomen/Pelvis with contrast are acceptable alternatives.
Initial screening age >=18: Individuals diagnosed at age ≥18: one-time PET/CT (78815 or 78816) using 68Ga-DOTA-SSA; FDG may substitute if DOTA radiotracers unavailable.one-time
Known pheochromocytoma/neuroendocrine tumors follow ONC-15 guidance.
Costello Syndrome surveillance
Costello Syndrome surveillance — Covered when ANY of the following are met
Post-genetic confirmation studies: Following confirmation of gene mutation: echocardiography (93306 or 93308 with 93321/93325), MRI Brain (70553) without and with contrast, MRI Cervical (72156) and Thoracic Spine (72157) without and with contrast.at_confirmation
Birth to 10 years abdominal surveillance: From birth to 10 years: abdominal and pelvic ultrasound every 3 months (76700 and 76856).every 3 months
Known cardiac disease: If known cardiac disease: follow pediatric cardiology echocardiography guidance for initial and repeat TTE indications.per cardiology guidance
CMMRD surveillance
Constitutional Mismatch Repair Deficiency (CMMRD) surveillance — Covered when ALL of the following are met
MRI brain frequency: After CMMRD diagnosis confirmed by genetic mutation: MRI Brain without and with contrast (70553) every 6 months.every 6 months
Endoscopic surveillance: Beginning at age 4 years: annual esophagogastroduodenoscopy and colonoscopy.annual starting age 4
Whole-body MRI: Beginning at age 6 years: annual whole-body MRI (76498).annual starting age 6
HLRCC surveillance
Hereditary Leiomyomatosis and Renal Cell Cancer (HLRCC) surveillance — Covered when ALL of the following are met
Eligibility and initiation age: Beginning at age 8 years for individuals with at least one qualifying feature (documented FH mutation, histologically confirmed multiple cutaneous piloleiomyomas, or two listed clinical manifestations): surveillance is indicated.age >=8 plus qualifying criteria
Annual imaging: Abdominal MRI with and without contrast (74183) annually.annual
BHDS surveillance
Birt-Hogg-Dube Syndrome (BHDS) surveillance — Covered when ALL of the following are met
Start age and frequency: All individuals beginning at age 20: MRI Abdomen (74183) and MRI Pelvis (72197) annually; if no family history of renal tumors and after two consecutive normal MRIs, frequency may be every 2 years.annual then every 2 years after 2 normals if no family history
BAP1 surveillance
BAP1 Tumor Predisposition Syndrome surveillance — Covered when ALL of the following are met
Start age and frequency: All individuals beginning at age 30: Abdominal MRI with and without contrast (74183) every 2 years.every 2 years starting age 30
HPRC surveillance
Hereditary Papillary Renal Carcinoma (HPRC) surveillance — Covered when ALL of the following are met
Start age and frequency: All individuals beginning at age 30: Abdominal MRI with and without contrast (74183) annually.annual starting age 30
HPRC surveillance
Covered when ALL of the following are met
HPRC annual MRI: Individual diagnosed with HPRC; begin surveillance at age 30 and perform abdominal MRI with and without contrast (CPT 74183) annually.start age = 30 years; frequency = annually
Based on autosomal dominant MET-associated risk.
DICER1 surveillance
Covered when ANY of the following syndrome-specific surveillance conditions apply
DICER1 lung surveillance infant: Asymptomatic DICER1 mutation: perform CT chest once at age 3–6 months and again at 2.5–3 years (contrast as requested); chest x-ray at birth and every 6 months until age 8, then annually until 12.specified_ages
DICER1 abdominal/pelvic surveillance: Asymptomatic DICER1 mutation: abdominal ultrasound every 3 months from birth to 8 years, then annually until 12; females continue abdominal and pelvic ultrasound annually until age 40.q3_months_birth_to_8y_then_annual
DICER1 thyroid surveillance: Baseline thyroid ultrasound by age 8 then every 3 years (CPT 76536).baseline_by_8_then_q3_years
MRI brain without and with contrast for new CNS symptoms.
Other renal predisposition syndromes surveillance
Covered when ALL of the following are met
Other renal predisposition syndromes abdominal US: Individuals with listed genetic variants or congenital anomalies associated with Wilms tumor: abdominal ultrasound (CPT 76700) every 3 months from birth to the 8th birthday.q3_months_birth_to_8y
Applies to enumerated gene variants and congenital anomalies.
Infantile myofibromatosis imaging criteria
Covered when the specified clinical scenarios are present
WBMRI for multifocal disease assessment: Assess for multifocal disease in children under two years: WBMRI (CPT 76498) once within 6 months of diagnosis.one-time within 6 months; age <2 years
Used to detect multifocal disease and guide targeted imaging.
MRI for symptomatic or pre-op planning: Pre-operative planning or signs/symptoms suggesting progression: MRI with and without contrast of symptomatic sites or sites requiring treatment.clinical indication present
Target imaging to symptomatic or surgical planning sites.
Visceral unresected disease: Unresected known visceral disease: MRI with and without contrast of involved visceral sites every 6 months until age two.
Bloom syndrome surveillance
Covered when the following are met
Bloom syndrome whole-body MRI: Whole-body MRI every 2 years starting at age 13 for malignancy screening, particularly lymphomas (CPT 76498).q2_years_starting_age_13
Wilms tumor screening per other renal predisposition guidance.
Neuroimaging for CNS symptoms
Covered when ANY of the following are met
CNS imaging: MRI Brain without and with contrast (70553) is medically necessary for individuals exhibiting CNS symptoms; CT Head (70450/70460) is medically necessary when urgent concerns exist and MRI would delay care (e.g., suspected intracranial hemorrhage).
Document CNS signs/symptoms in request.
Initial staging for suspected mediastinal / lymphoblastic disease
Covered when ALL of the following are met
Mediastinal/airway evaluation: Chest x-ray for mediastinal mass; if mediastinal widening and airway compromise or anesthesia safety concern exist, CT Chest with contrast (71260) is medically necessary.
For suspected T-cell/lymphoblastic lymphoma initial staging, either CT neck/chest/abdomen/pelvis with contrast OR PET/CT (78816) is acceptable.
Staging for T-cell/lymphoblastic lymphoma: Either CT Neck (70491) + CT Chest (71260) + CT Abdomen/Pelvis (74177) with contrast OR PET/CT (78816) is medically necessary for initial staging of suspected lymphoblastic disease.
Document histology suspicion and airway/anesthesia concerns.
Imaging for bulky nodal disease and residual masses
Covered when ALL of the following are met
CT for response: CT is medically necessary to assess response only for individuals with known bulky nodal disease at end of induction (4–6 weeks) and for persistent residual masses during therapy phases (generally every 8–12 weeks) until resolution.
CT of all involved bulky nodal areas may be required as part of end-of-therapy evaluation.
PET/CT for residual mass: PET/CT (78815) is medically necessary when a residual mass ≥8 mm on recent CT is present and immediate radiation or chemotherapy planning depends on PET results.Residual mass ≥8 mm
Residual mass without PET-avidity is considered complete response at extranodal site.
Imaging for infectious concerns during immunosuppression
Covered when ALL of the following are met
Infectious imaging during immunosuppression: CT or MRI is medically necessary for infectious concerns in individuals with ALL who have ANC <500 or when chest x-ray/ultrasound findings are inconclusive at any ANC during active treatment.ANC <500
MRA/MRV of head indicated to evaluate sinus venous thrombosis in individuals treated with asparaginase.
Surveillance imaging for invasive fungal infection: Surveillance imaging of asymptomatic individuals to detect invasive fungal infection is medically necessary only when acute clinical decisions will be made based on the imaging.
Frequent CT may be indicated to evaluate known invasive fungal infection.
Imaging for osteonecrosis in ALL
Covered when ANY of the following are met
Symptomatic joint evaluation: MRI without contrast or without and with contrast of affected joint(s) is medically necessary for symptoms suggesting osteonecrosis; CT without contrast is medically necessary if MRI contraindicated or for suspected subchondral fracture.
Screening MRI hips: MRI bilateral hips (73721 or 73723 with modifier -50) is medically necessary once at 6–9 months after diagnosis for individuals age ≥11 years.Age ≥11; timing 6–9 months post-diagnosis
Repeat MRI every ~6 months if steroid reintroduction is being considered.
Monitoring during maintenance: Repeat MRI without contrast of affected joints every 2 cycles of maintenance (~6 months) is medically necessary if reintroduction of corticosteroids is being considered in previously symptomatic individuals whose symptoms have resolved.
MRI without contrast is preferred for serial evaluation.
Relapsed ALL — infection imaging
Covered when ANY of the following are true
Infection imaging: Frequent CT or MRI imaging is medically necessary to evaluate known or suspected new sites of invasive fungal or other aggressive infections in relapsed ALL.
Surveillance of asymptomatic individuals only when imaging will drive acute clinical decisions.
Osteonecrosis — ALL
Covered when ALL of the following are met
Symptomatic ON evaluation: MRI without contrast or without and with contrast of affected joint(s) is medically necessary for symptoms suggesting osteonecrosis; CT without contrast is medically necessary when MRI is contraindicated or unavailable, or for suspected subchondral fracture.
Screening/monitoring: MRI bilateral hips (CPT 73721 or 73723 with modifier -50) is medically necessary once at 6–9 months after diagnosis for individuals age ≥11 years; repeat MRI every 2 cycles of maintenance (~6 months) if steroid reintroduction is being considered.age ≥11
Preoperative planning: MRI without contrast of the affected joint(s) is medically necessary for preoperative planning for individuals undergoing core decompression.
AML — imaging
Covered when ANY of the following are true
Infection imaging AML: Frequent CT or MRI imaging is medically necessary to evaluate known sites of invasive fungal infection in AML.
Surveillance of asymptomatic individuals only when imaging will drive acute clinical decisions.
Bulky tumor imaging: Advanced imaging may be approved on a case-by-case basis for rare AML individuals with bulky tumor masses (chloromas/leukemic sarcomas) noted on exam or other imaging.
Document clinical need and impact on management.
CNS tumors — modality & timing
Covered when ALL of the following modality- and timing-specific conditions are met
Modality preference: MRI is the preferred imaging modality for pediatric CNS tumors; MRI Brain without and with contrast (70553) is the primary study and should be performed without and with contrast initially to avoid repeat anesthesia exposures.
CT is reserved for specific acute/operative indications or when MRI unsafe/unavailable.
Advanced MRI for preop planning: Functional MRI (fMRI) and isotropic volumetric MRI (76376/76377/0865T/0866T) are medically necessary for preoperative planning to depict eloquent cortex and accurately localize tumors.
Tractography and other advanced sequences may be included when clinically required.
MRS and PET indications: MR Spectroscopy and PET Brain Metabolic imaging are medically necessary only for specified histologies or diagnostic questions (e.g., distinguishing necrosis vs progression within 18 months, indeterminate lesions where metabolic data will alter biopsy/treatment decisions); they are not medically necessary for routine surveillance.
PET brain/perfusion and PET/CT fusion have limited roles and are generally not indicated for primary CNS tumor management.
CNS Low-Grade Glioma — coverage criteria
Covered when the following diagnosis-specific staging, treatment response, and surveillance criteria are met
Initial staging LGG: MRI Brain without and with contrast (70553) and MRI Spine without and with contrast (72156/72157/72158) are medically necessary for initial staging; MRI Orbits (70543) if visual signs/symptoms present.
CT Head (70450) is appropriate for rapid acute assessment (hemorrhage, ventriculomegaly, shunt issues).
PET or MRS for specific clinical questions: PET Brain metabolic imaging (78608) or MR Spectroscopy (76390) may be medically necessary to determine need for biopsy/resection in specified scenarios, to distinguish grade, or to differentiate radiation necrosis from progression within 18 months post-radiotherapy; these are not for routine surveillance.
Document clinical question and how results will alter management.
Baseline and post-treatment imaging: Baseline MRI after resection and imaging at completion of radiotherapy should use MRI Brain without and with contrast (70553); MRI Spine as indicated by resection site.
Treatment response imaging on chemotherapy: MRI Brain every 2 cycles; MRI Spine every 2 cycles for measurable spinal disease.
CNS Low Grade Gliomas (LGG) (PEDONC-4.2)
Medically necessary imaging and indications for pediatric low-grade gliomas
Indications for PET Brain Metabolic imaging: Use PET Brain (78608) when determining need for biopsy if transformation to high grade suspected or when PET findings will determine whether biopsy/resection can be safely postponed for indeterminate lesions.
PET/ MRS not for routine surveillance.
Indications for MR Spectroscopy: Use MR Spectroscopy (76390) to distinguish low vs high grade gliomas, evaluate indeterminate lesions to decide biopsy timing, or to distinguish radiation necrosis from progression within 18 months post-radiotherapy.
MRS not routinely indicated for surveillance.
Baseline post-resection imaging: MRI Brain without and with contrast (70553) and MRI of resected spinal site (spine CPTs) or MRI Orbits (70543) for orbital resections are medically necessary to assess degree of resection.
Post-resection baseline imaging guides further therapy.
Initial staging, perioperative and surveillance imaging for HGG (ONCP.CT.0004.3.A)
Medically necessary imaging and indications for pediatric high-grade gliomas
Initial staging of HGG: MRI Brain without and with contrast (70553) and MRI Spine without and with contrast (72156/72157/72158) are medically necessary for initial staging; isotropic volumetric MRI and/or fMRI may be used for preoperative planning.
CT head without contrast (70450) acceptable for acute settings.
PET/MRS uses for HGG: PET Brain (78608) and MR Spectroscopy (76390) are medically necessary to distinguish radiation necrosis vs progression within 18 months, to evaluate inconclusive MRI when metabolic data will guide biopsy/therapy change, and for other specified diagnostic dilemmas.
Document how result will change management.
Baseline post-resection imaging: MRI Brain without and with contrast preferably within 48 hours post-op to quantify residual tumor; MRI Spine as indicated for resected spinal disease.preferably within 48 hours
Medulloblastoma, other CNS embryonal tumors, and pineoblastoma (PEDONC-4.4)
Medically necessary imaging for medulloblastoma, other embryonal CNS tumors, and pineoblastoma (PEDONC-4.4)
Initial staging (preoperative): MRI Brain without and with contrast (70553) and MRI Spine without and with contrast (72156/72157/72158) are required for initial staging; isotropic volumetric MRI and/or fMRI may be used for preoperative planning; CT head without contrast (70450) allowed in acute settings.
PET/MRS use exceptions: PET Brain (78608) and MR Spectroscopy (76390) are medically necessary for specified indications (distinguishing radiation necrosis vs progression within 18 months; evaluating indeterminate lesions where PET/MRS will influence biopsy/therapy). They are not medically necessary for routine surveillance.
Postoperative imaging timing: Postoperative MRI (70553) preferably within 48 hours to quantify residual tumor; MRI Spine within 28 days post-op if not performed preoperatively.within 48 hours brain; within 28 days spine
ATRT - Covered imaging
Covered when indicated for ATRT
Initial staging: MRI Brain without and with contrast (70553) AND MRI Spine without and with contrast (72156/72157/72158) AND renal ultrasound (76770) at diagnosis; isotropic volumetric MRI and/or fMRI may be used for preoperative planning; CT head without contrast (70450) for acute issues.
PET Brain metabolic imaging not defined/necessary for ATRT; MRS not for routine surveillance.
Postoperative and treatment response: Postoperative MRI Brain within 48 hours preferred; MRI Spine within 28 days if not done pre-op; treatment response imaging after every 2 cycles of induction chemotherapy (MRI Brain and Spine).
End-of-treatment MRI brain and spine required; signs/symptoms prompt immediate imaging.
Surveillance: MRI Brain and MRI Spine every 3 months for 2 years, then every 6 months for 3 years, then annually up to 10 years post therapy.
See long-term follow-up guidance for post-radiation care.
Pineal tumors - Covered imaging
Covered when indicated for pineal parenchymal tumors
Initial staging: MRI Brain without and with contrast (70553) is required for initial staging; MRI Spine if multicentric, atypical histology, or symptoms suggesting spinal involvement; isotropic volumetric MRI or fMRI may be used for preoperative planning; CT head (70450) acceptable for acute issues.
PET Brain and MRS have no defined routine role for pineocytoma.
Surveillance: MRI Brain every 3 months for 1 year, then every 4 months for 1 year, then every 6 months for 1 year, then annually thereafter; MRI Spine schedule matches brain if cord involvement present.
Signs or symptoms of recurrence warrant MRI brain/spine as indicated.
CNS Germ Cell Tumors - Covered imaging
Covered when indicated for CNS germ cell tumors (germinoma and non-germinomatous germ cell tumors)
Initial staging: MRI Brain without and with contrast (70553) AND MRI Spine without and with contrast (72156/72157/72158) are required for initial staging; isotropic volumetric MRI and/or fMRI may be used for preoperative planning; CT head (70450) acceptable for acute settings.
PET Brain metabolic imaging does not have a defined role and is considered not medically necessary.
Treatment response: MRI Brain every 2 cycles during induction chemotherapy; MRI Spine every 2 cycles if measurable spinal disease; end-of-therapy MRI Brain and Spine as indicated; surveillance every 3 months for 1 year, then spacing per guideline to 5 years.
Document response schedule per treatment plan.
Recurrence: Suspected recurrence or new/worsening neurologic symptoms (including DI) -> MRI Brain (70553) and MRI Spine (72156/72157/72158) as indicated.
Ependymoma - Covered imaging
Covered when indicated for ependymal tumors
Initial staging: MRI Brain without and with contrast (70553) AND MRI Spine without and with contrast (72156/72157/72158) are required for initial staging; isotropic volumetric MRI and/or fMRI may be used for preoperative planning; MRS may be used when it will influence decision to postpone biopsy/resection.
PET Brain metabolic imaging has no defined role for ependymoma.
Treatment response and end of therapy: MRI Brain or involved spinal level(s) after resection and at completion of radiotherapy; MRI Brain and Spine at end of induction and end of all planned therapy.
Prior to radiotherapy MRI of all known measurable disease is required.
Surveillance - intracranial without spinal history: MRI Brain every 3 months for 2 years, then every 4 months for 1 year, then every 6 months in years 4–5, then annually to 10 years post treatment; MRI Spine may be approved annually for 2 years. If spinal involvement at diagnosis, MRI Spine follows intensive schedule identical to brain.
Ependymal Tumors
Coverage guidance for ependymal tumors
Ependymal tumor imaging guidance: Surgery is primary treatment; complete resection -> image per surveillance guidelines; incompletely resected or high-risk histology or infratentorial location -> radiotherapy ± chemotherapy and surveillance per guideline after end of radiotherapy imaging.
Individuals with specific molecular features (e.g., chromosome 1q gain) may have different prognoses but not necessarily different surveillance cadence.
Malignant Spinal Cord Tumors
Coverage guidance for malignant spinal cord tumors
Initial staging: MRI Brain without and with contrast (70553) AND MRI Spine without and with contrast (72156/72157/72158) are required for initial staging; isotropic volumetric MRI brain and/or fMRI may be used for preoperative planning.
During treatment response: MRI Spine without and with contrast every 2 cycles for treatment response; additionally MRI Brain when intracranial disease is known.every 2 cycles
Signs or symptoms of recurrence/progression: MRI Spine without and with contrast; MRI Brain if intracranial disease present; surveillance individualized for rare histologies after specialist evaluation.
Craniopharyngioma and Sellar Region Tumors
Coverage guidance for craniopharyngioma and other sellar region tumors
Initial staging: MRI Brain without and with contrast (70553); add CT Head without contrast (70450) concurrently if craniopharyngioma suspected. Isotropic volumetric MRI and/or fMRI may be used for preoperative planning.
PET Brain metabolic imaging and MR Spectroscopy are not medically necessary for craniopharyngioma.
Treatment response: MRI Brain without and with contrast (70553) every 2 cycles during active chemotherapy and at end of planned chemotherapy; MRI Spine every 2 cycles if measurable spinal disease.every 2 cycles
Surveillance: MRI Brain every 3 months x1 year, then every 4 months x1 year, then every 6 months x1 year, then annually to 10 years.
Signs or symptoms of recurrence: MRI Brain (70553) ± CT Head (70450) for craniopharyngioma; MRI Spine (72156/72157/72158) if spinal symptoms.
Choroid Plexus Tumors
Coverage guidance for choroid plexus papilloma, atypical papilloma/adenoma, and carcinoma
Papilloma - suspected/diagnosis: MRI Brain without and with contrast (70553) is medically necessary; isotropic volumetric MRI and/or fMRI may be used for preoperative planning; MRS may be used when it will alter timing of biopsy/resection.
Evaluate hydrocephalus with MRI if suspected.
Atypical/adenoma - suspected/diagnosis: MRI Brain (70553) AND MRI Spine (72156/72157/72158) for staging; preoperative volumetric MRI and/or fMRI as indicated; MRS when helpful to defer biopsy/resection.
Carcinoma - initial staging and peri-treatment: MRI Brain (70553) AND MRI Spine (72156/72157/72158) for initial staging; pre-radiotherapy and completion of radiotherapy imaging per above; treatment response MRI Brain every 2 cycles and MRI Spine every 2 cycles if measurable spinal disease; surveillance cadence varies by cord involvement status.
Surveillance schedules provided in guideline (e.g., every 4 months x3 years then spacing), with MRI Spine at 12 and 24 months if no cord involvement.
CNS Lymphoma and Meningioma
Coverage guidance for CNS lymphoma and meningiomas in pediatrics
CNS lymphoma: Imaging indications align with general CNS lymphoma guidance; follow disease-specific oncology imaging guidelines and, if systemic involvement, refer to pediatric aggressive mature B-cell NHL guidance.
Meningioma: Pediatric meningioma imaging indications follow general imaging guidelines; follow adult meningioma imaging guidance adapted for pediatric care.
CPT/HCPCS codes and grouped coding guidance
Investigational/Experimental CPTCPTExperimental
C9791
MRI utilizing Xenon Xe 129 (investigational per document)
3D Rendering CPT CodesCPTCovered
76376
3D rendering; not requiring image post-processing on an independent workstation
76377
3D rendering; requiring image post-processing on an independent workstation
Imaging Guidance and Related Procedure CodesCPTCovered
19085
Biopsy, breast, with placement of breast localization device(s); first lesion, including MR guidance
19086
Biopsy, breast, with placement of breast localization device(s); each additional lesion, including MR guidance
75989
Imaging guidance for percutaneous drainage with placement of catheter
76942
Ultrasonic guidance for needle placement
77011
CT guidance for stereotactic localization
77012
CT guidance for needle placement
77013
CT guidance for, and monitoring of parenchymal tissue ablation
77021
MR guidance for needle placement
77022
MR guidance for, and monitoring of parenchymal tissue ablation
Unlisted Procedure CodesCPT
76497
Unlisted CT procedure (diagnostic or interventional)
76498
Unlisted MR procedure (diagnostic or interventional)
78999
Unlisted procedure, diagnostic nuclear medicine
Referenced Related CodesCPT
20982
CT guidance for bone tumor ablations (referenced)
Unlisted procedure codesCPT
76497
Unlisted CT procedure (e.g., diagnostic or interventional)
76498
Unlisted MR procedure (e.g., diagnostic or interventional)
78999
Unlisted procedure, diagnostic nuclear medicine
Limited CTCPT
76380
Limited or Follow-up CT
SPECT/CT and related nuclear codesCPT
78830
SPECT/CT, single area, single day
78831
SPECT/CT, 2 or more days
78832
SPECT/CT, 2 areas with one day and 2-day study
78072
SPECT/CT parathyroid nuclear imaging
Outside study interpretationCPT
76140
Interpretation of an outside study
PET/MRI reporting combinationCPT
78813
PET Whole-Body
76498
MRI Unlisted (used in PET/MRI reporting)
HCPCS examples and guidanceHCPCS
C8931
MRA with dye, Spinal Canal (example HCPCS mapping)
S8042
MRI, lowfield (non-specific HCPCS example to redirect to CPT)
Medically Necessary MRI BrainCPTCovered
70553
MRI Brain without and with contrast
CT Head when MRI contraindicatedCPTCovered
70470
CT Head without and with contrast
Bone Scan / Nuclear Medicine CodesCPT
78306
Nuclear bone scan whole-body
78803
Radiopharmaceutical localization (planar) SPECT
78831
Radiopharmaceutical localization (SPECT) another descriptor
78830
SPECT/CT
78832
SPECT/CT additional descriptor
78300
Nuclear bone scan limited
78305
Nuclear bone scan multiple areas
78315
Nuclear medicine code listed with no oncology indications
Cardiac Function Assessment CodesCPTCovered
93306
Echocardiography — complete
93307
Echocardiography with Doppler
93308
Echocardiography transesophageal or other variant
78472
MUGA (multigated acquisition) blood pool nuclear medicine scanning
Cardiac imaging codesCPTCovered
93306
Echocardiography (as listed)
93307
Echocardiography (as listed)
93308
Echocardiography (as listed)
78472
MUGA blood pool nuclear medicine scanning
Bone scan codesCPTCovered
78300
Bone scan
78305
Bone scan
78306
Bone scan
78803
Nuclear medicine code listed with bone scan options
78830
Nuclear medicine code listed with bone scan options
78832
Nuclear medicine code listed with bone scan options
MIBG and related nuclear medicine codesCPTCovered
78801
I-123 MIBG scintigraphy
78802
I-123 MIBG scintigraphy
78804
I-123 MIBG scintigraphy
78831
Nuclear medicine additive code
78800
Limited MIBG for single site follow up (not sufficient for initial workup)
PET and PET/MRI reporting codesCPTCovered
78815
PET/CT skull base to mid-femur ('eyes to thighs')
78816
Whole-body PET/CT
78813
PET whole-body (for PET/MRI reporting combination)
76498
MRI unlisted (used with CPT 78813 for PET/MRI reporting)
78812
PET code (not appropriate for unbundled reporting with diagnostic CT)
Prior authorization, documentation, and billing rules
Billing Rule
Use of CPT 76380 for treatment planning
CPT 76380 (Limited or follow-up CT) is not medically necessary when used solely for treatment planning. CPT 76380 describes a limited CT where the work of a full diagnostic CT code is not performed; it is inappropriate to report 76380 to cover 'extra slices' or for routine treatment planning when an appropriate diagnostic CT code or a designated treatment-planning code (e.g., CPT 76498 for certain oncology planning) is indicated. Providers should select the correct diagnostic or treatment-planning code rather than using 76380 for planning purposes.
CPT ® 76380 is not medically necessary for treatment planning purposes.
Do not report CPT ® 76380 in conjunction with diagnostic CT codes to cover extra slices.
Denial Risk
No explicit denial or step-therapy rules listed
Surveillance and follow-up imaging frequency rules
CT or MRI frequency after every 2 cycles
Treatment response imaging cadenceCT or MRI: perform imaging for treatment response after every 2 cycles (~6 weeks for solid tumors; ~8–12 weeks for CNS tumors)
Repeat imaging rationaleRepeat studies are medically necessary only when results will affect clinical management or show progression/recurrence
Pre-evaluation requirementObtain and document pertinent clinical evaluation prior to advanced imaging unless guideline-supported scheduled surveillance
Ultrasound every 3 months
Abdominal ultrasound frequencyEvery 3 months — abdominal ultrasound recommended every 3 months in listed syndromes (e.g., BWS, WAGR) during early childhood)
Context of use
Guidance on contrast use, anesthesia considerations, and contraindications
Note
Note
Note
Note
Note
Note
Note
Services and scenarios considered not medically necessary
Unbundling a combined PET/CT study into separate PET and diagnostic CT procedure codes is not supported. PET/CT is performed as a single integrated study (typically reported as CPT 78815 or 78816), and separating the PET portion from a diagnostic CT for billing is considered inappropriate and may be denied.
PET is generally reserved for defined oncologic indications and is not medically necessary for routine surveillance unless a condition-specific guideline explicitly allows it; PET/CT should be requested only when conventional imaging is equivocal or will not answer the clinical question and when the clinical submission documents the specific management decision that will be guided by PET results.
3D post-processing codes (CPT 76376 and 76377) have strict billing limitations. They must represent true 3D rendering and concurrent physician supervision/participation, and should not be reported for routine 2D reformatting.
These 3D rendering codes should not be billed in conjunction with a wide range of other procedures (including CAD, MRA, CTA, SPECT, PET/PET-CT, stereotactic localization like CPT 77011 / CPT 70486, mammography/MRI breast, CT colonography, cardiac MR/CT, or coronary CTA) because those procedures either inherently produce 3D datasets or are incompatible with separate 3D rendering billing.
Routine advanced imaging (MRI, CT, PET, nuclear medicine) for asymptomatic individuals without signs or symptoms of systemic cancer involvement is generally not medically necessary. Requests for screening or surveillance in asymptomatic patients must reference a condition-specific guideline that explicitly permits such imaging.
PET/CT in particular is not indicated for routine surveillance; PET is reserved for situations where conventional imaging is equivocal or when a documented clinical decision depends on PET findings. Prior clinical evaluation and documentation of the diagnostic question are required before approving advanced imaging.
Purpose and scope
These guidelines are evidence-based clinical criteria that govern advanced imaging selection and use for pediatric and special oncology populations. They apply the principle that advanced imaging is appropriate when ordered after a pertinent clinical evaluation, when the modality and timing are matched to the clinical question, and when documentation supports that the imaging result will affect management.
The guidance emphasizes age-based routing (individuals ≤18 years follow pediatric-specific schedules), radiation-safety considerations (prefer MRI/US over CT/nuclear studies when feasible), and avoidance of overutilization—repeat or duplicative studies without demonstrated impact on care may be denied. Prior authorization determinations will follow the Ohio Administrative Code and require sufficient clinical documentation to establish medical necessity.
Guideline development and intent
Evidence-based intentGuidelines are evidence-based, annually reviewed, and intended to guide appropriate imaging while preserving clinician judgment
ScopeCovers advanced imaging and procedures across multiple modalities for pediatric and special oncology populations
Clinical judgment statementGuidelines do not supersede physician judgment; exceptions may apply in individual circumstances
Key definitions and syndrome summaries
Investigational/Experimental definition
Investigational/Experimental definitionProcedures may be considered investigational/experimental if there is paucity of evidence, lack of demonstrated clinical utility, immature evidence of improved outcomes, or lack of collective opinion of support
Supporting evidence criteriaSupporting evidence includes peer-reviewed literature, randomized trials, cohort studies with sufficient power, or specialty society recommendations
Implication for coverageInvestigational/experimental designation may result in non-coverage under policy review per Ohio rules
Pediatric routing by age
Pediatric routing by ageIndividuals ≤18 years should be imaged per Pediatric Imaging Guidelines; individuals >18 follow General Imaging Guidelines unless specified
Use in policy
Prior authorization expectations
Note
Note
Note
Note
Note
Note
Note
Policy changes and versioning
2026-02-03policy_effectiveLatest
Policy effective date for Pediatric and Special Populations Oncology Imaging Guidelines (Ohio) set as February 3, 2026 (version V1.0.2026).
v1.0.2026version_label
Guideline developed as evidence-based pediatric oncology imaging guidance (version V1.0.2026).
Policy Summary
PayerColorado Rocky Mountain Health Plans
PolicyPediatric and Special Populations Oncology Imaging Guidelines (For Ohio Only)
Policy CodePolicy CSRAD021OH.E
Change TypeTechnical / No material change
Effective DateFeb 3, 2026
Next Review Date
Key ActionSubmit adequate clinical documentation and, when required, obtain prior authorization per Ohio Administrative Code 5160-1-01 to establish medical necessity for advanced imaging.
Consider renal function, pregnancy, allergies, and implant contraindications when selecting contrast and modality; when GFR <30 mL/min exercise parity risk for CT and MRI contrast decisions.
GFR <30 mL/min
Limit GBCA use to situations where contrast materially alters management.
Avoidance of overutilization: Repeat, duplicative, or higher-level imaging without demonstrated impact on management is discouraged and may be denied; double-contrast CTs have limited indications.
Pre-operative imaging must align with necessity of underlying procedure and prior imaging review.
Recurrence: Imaging when recurrence or progression is suspected or documented by clinical signs, labs, or basic imaging; studies recommended for initial staging of that cancer type should be approved for recurrence and modality consistency during treatment is preferred.
Refer to diagnosis-specific PET indications for recurrence.
age_18_plus
7_months_to_5_years_q3_months
After age 5: annual WBMRI.
Post-age 5 surveillance: After age 5 years: annual whole-body MRI (76498); clinical symptoms or suspicious WBMRI findings prompt targeted advanced imaging (CT or MRI without and with contrast).age_gt_5_annual
After age 5: annual WBMRI.
After age 5 surveillance: After age 5 years: Annual WBMRI (76498).annual
Clinical symptoms or suspicious WBMRI findings: targeted CT or MRI without and with contrast.
Symptomatic or suspicious findings: Clinical symptoms or WBMRI findings suggesting malignancy: targeted advanced imaging (CT with/without contrast or MRI without and with contrast) of suspected disease site.as clinically indicated
every_6_months_until_age_2
CT may be used for chest/abdomen surveillance but should not duplicate simultaneous MRI.
Post-operative evaluation MRI: One-time MRI with and without contrast for post-operative evaluation when adequacy of resection is unclear and re-excision is being considered.one-time
For surgical decision-making.
Preoperative planning: MRI without contrast of affected joint(s) is medically necessary for preoperative planning for individuals undergoing core decompression.
CT without contrast allowable when MRI contraindicated.
Perioperative imaging: Definitive imaging should be completed prior to biopsy; MRI Brain without and with contrast is medically necessary one time in the immediate preoperative period to support surgical planning (e.g., diffusion-tensor imaging, perfusion, tractography).
Postoperative MRI within 48 hours preferred to quantify residual tumor volume.
Surveillance LGG: For intracranial primary LGG: MRI Brain without and with contrast every 3 months for 2 years, then every 6 months for 3 years, then annually thereafter; MRI Spine surveillance not necessary without prior spinal involvement.
Adjust intervals for orbital or spinal primaries per guidance.
Treatment response on chemotherapy: MRI Brain without and with contrast every 2 cycles during active chemotherapy and at end of planned therapy; MRI Spine every 2 cycles for measurable spinal cord disease.every 2 cycles
Surveillance for intracranial primary LGG: MRI Brain without and with contrast every 3 months for 2 years, then every 6 months for 3 years, then annually thereafter; MRI Spine not medically necessary during surveillance without prior spinal involvement.
Include MRI Orbits if prior orbital involvement.
Surveillance for spinal primary or metastatic LGG: MRI Spine without and with contrast every 3 months for 2 years, then every 6 months for 3 years, then annually thereafter.
Treatment response on chemotherapy: MRI Brain every 2 cycles during active treatment and at end of planned chemotherapy; MRI Spine every 2 cycles for measurable spinal disease.every 2 cycles
Surveillance for intracranial HGG: MRI Brain every 2 months for 1 year, then every 3 months thereafter; MRI Spine not necessary during surveillance without prior spinal involvement.
Treatment response and end-of-treatment imaging: MRI Brain and MRI Spine without and with contrast at start of adjuvant chemotherapy and every 2 cycles until therapy completion; for children <3 years treated with repeated chemo in lieu of radiotherapy, disease evaluations prior to each cycle (every 4–6 weeks) may be indicated.every 2 cycles; every 4–6 weeks for some young children
Surveillance schedules: Low/average-risk: MRI Brain every 3 months for 2 years then every 6 months for 3 years with Spine every 6 months for 2 years; High/very high-risk: MRI Brain every 3 months for 2 years then every 6 months for 3 years with Spine every 3 months for 2 years then annually for 3 years.
Refer to long-term follow-up guidance after radiation therapy.
Covered CPT Codes - Volumetric MRICPTCovered
76376
Isotropic volumetric MRI
76377
Isotropic volumetric MRI (alternate)
0865T
Isotropic volumetric MRI (add-on)
0866T
Isotropic volumetric MRI (add-on alt)
Covered CPT Codes - Functional MRICPTCovered
70555
fMRI with contrast (or functional MRI)
70554
fMRI without contrast
MR SpectroscopyCPT
76390
MR Spectroscopy
CT Head (acute/rapid assessment)CPTCovered
70450
CT Head without contrast
Referenced imaging CPT codesCPT
70553
MRI Brain without and with contrast
72156
MRI Cervical Spine without and with contrast
72157
MRI Thoracic Spine without and with contrast
72158
MRI Lumbar Spine without and with contrast
76376
Isotropic volumetric MRI Brain (sequence) — CPT group
76377
Isotropic volumetric MRI Brain (sequence) — CPT group
0865T
Isotropic volumetric MRI Brain (add-on)
0866T
Isotropic volumetric MRI Brain (add-on)
70555
Functional MRI (fMRI) - with correlation
70554
Functional MRI (fMRI) - without correlation
1–10 of 16
1/2
Renal function threshold
Renal function thresholdGFR <30 mL/min (contrast risk parity for iodinated CT and gadolinium MRI)
When to use CT without contrastElevated BUN/creatinine, renal insufficiency, or other contrast contraindication — use CT without contrast if CT with contrast criteria met but contrast contraindicated
Gadolinium risk noteGadolinium-associated risks (NSF, deposition) increase with low GFR; limit GBCA use to when additional information is necessary
Absolute neutrophil count (ANC)
Absolute neutrophil count (ANC) triggerANC <500 — approve imaging for infectious concerns during active chemotherapy
ANC-equivalent conditionIndividuals receiving supplemental IVIG for therapy-induced hypogammaglobulinemia should be treated similarly to ANC <500 for infection imaging
Urgency noteRequests for infectious disease imaging in severely immunocompromised patients should be approved immediately
PET lesion detectability threshold
PET lesion detectabilityPET is not reliable for detection of lesions smaller than 8 mm — PET lesion detectability threshold < 8 mm
PET timing after radiationDelay PET/CT for at least 12 weeks after completion of radiation unless required sooner for imminent surgery
Preferred PET modalityUse PET/CT fusion imaging (CPT 78815 or 78816) rather than PET alone
No explicit, standalone denial criteria or a formal step therapy requirement are specified in this excerpt. However, services described as investigational, experimental, unproven, or without adequate supporting evidence may be denied per the policy's investigational/experimental rules. Documentation insufficiency or failure to meet stated clinical criteria may also trigger denial or require further review.
No step therapy rules specified in this excerpt.
Denial may result when services are investigational, lack supporting evidence, or when required documentation is insufficient.
Documentation Required
Required documentation for medical necessity
Requests for advanced imaging or other designated procedures must include adequate clinical information to establish medical necessity. Required documentation includes a pertinent clinical evaluation (history, physical exam), relevant laboratory studies, and prior imaging when applicable. Condition-specific guideline sections may require additional documentation. Documentation of physician supervision is recommended for 3D post-processing codes (CPT 76376/76377). For individuals enrolled in clinical trials, provide protocol details (COG roadmap or study documentation) when requesting exceptions.
Pertinent clinical evaluation since onset or change in symptoms (detailed history, physical exam).
Appropriate laboratory studies and prior imaging studies (e.g., x-rays for spine/musculoskeletal requests).
Documentation of physician participation/supervision for CPT ® 76376 and CPT ® 76377 3D post-processing.
COG protocol documentation when requesting exceptions based on trial protocols.
Prior Authorization
Therapy sequencing and timing notes
Therapy sequencing and timing expectations are noted in condition-specific sections: repeat or surveillance imaging should be justified by new/worsening symptoms, evidence of progression or when it will meaningfully affect management. Pre-operative or pre-procedural imaging is not medically necessary if the underlying surgery/procedure is not medically necessary. When multiple supported body areas require imaging under anesthesia in pediatric patients, obtain them in the same session to avoid repeat anesthesia.
Repeat imaging is generally unnecessary unless there is disease progression, recurrence, or the imaging will affect clinical management.
Pre-operative imaging is conditional on the underlying procedure being medically necessary.
Plan concurrent imaging under a single anesthesia session in pediatric patients when multiple body areas are indicated.
Note
Other provider actions
None specified in this excerpt beyond the general expectations above; providers should follow condition-specific guideline sections for any additional provider actions, prior authorization requirements, or documentation elements.
Providers must consult the applicable condition-specific guideline for any additional authorization or documentation requirements.
Documentation insufficiency may trigger denial or request for additional information.
Used for renal/adrenal surveillance from birth through early childhood as specified per syndrome guidance
Purely cystic adrenal mass guidanceFor purely cystic adrenal masses in BWS, continue ultrasound every 3 months and advanced imaging is not medically necessary
MRI annual
Annual MRI recommendationMRI — Annual (e.g., annual MRI brain in Li-Fraumeni and NF1 surveillance where specified)
Modality preferenceMRI is preferred for CNS and other indications when feasible to avoid radiation in young children
Code exampleMRI Brain without and with contrast (CPT 70553) commonly cited for annual surveillance
MRI every 3 years
Every 3 years MRIMRI Spine every 3 years for individuals without spinal tumor history (NF1) — surveillance interval = every 3 years
When to image soonerIndividuals with prior spinal tumor history require annual MRI Spine instead of q3yr
CPT examplesMRI Spine CPTs 72156/72157/72158 specified for thoracic/cervical/lumbar imaging
Monthly ultrasound series from birth to 6 months
Infant intensive US scheduleMonthly ultrasound series from birth to 6 months: US head (CPT 76506), US abdomen (CPT 76700), US pelvis (CPT 76856), US neck (CPT 76536)
Baseline WBMRIBaseline whole-body MRI (CPT 76498) at diagnosis is recommended and used to direct targeted imaging
Follow-up MRI for inconclusive USIf ultrasound findings are inconclusive, MRI of the inconclusive site is medically necessary and replaces US for remainder of planned screening
Monthly Ultrasound (head, abdomen, pelvis, neck)
Monthly ultrasound sitesMonthly ultrasound of head (76506), abdomen (76700), pelvis (76856), and neck (76536) as part of intensive infant surveillance
Use in RTPSPart of Rhabdoid Tumor Predisposition Syndrome surveillance from birth to 6 months monthly
Pathway for inconclusive resultsInconclusive US prompts MRI with and without contrast of that site, replacing US for remaining schedule
Ultrasound and MRI (brain, spine) every 3 months
Every 3 months combined surveillanceFrom 7 months to 5 years: every 3 months perform US abdomen/pelvis/neck plus MRI brain (70553) and MRI spine (72156/72157/72158) with and without contrast
Syndrome contextSpecified for Rhabdoid Tumor Predisposition Syndrome toddler surveillance
Targeted advanced imagingMRI with and without contrast of areas of concern found on baseline WBMRI included in the q3 month protocol
Whole-body MRI or Abdominal MRI — Annual
Annual whole-body or abdominal MRIAnnual whole-body MRI (CPT 76498) or abdominal MRI (CPT 74183) is recommended annually for specified syndromes after infancy/age thresholds
ExamplesAnnual WBMRI after age 5 for RTPS; annual WBMRI for CMMRD beginning at age 6; annual abdominal MRI for HLRCC starting age 8
Reporting code for WBMRIReport WBMRI using CPT 76498 (no established CPT/HCPCS codes otherwise)
MRI hips once at 6-9 months for age ≥11
Hip MRI one-time screeningMRI bilateral hips (CPT 73721/73723) — once at 6–9 months after diagnosis for individuals age ≥11 years to screen for osteonecrosis
Repeat monitoringRepeat hip MRI every ~6 months (every 2 cycles of maintenance) if corticosteroid reintroduction is contemplated
Modality preferenceMRI without contrast preferred for osteonecrosis evaluation; CT without contrast only if MRI contraindicated
MRI Brain LGG surveillance cadence
LGG brain surveillance cadenceMRI Brain (70553) every 3 months for 2 years, then every 6 months for 3 years, then annually thereafter (intracranial LGG)
Spine surveillance in LGGMRI Spine surveillance not necessary without prior spinal involvement; if spinal primary or metastatic spine: MRI Spine every 3 months for 2 years, then every 6 months for 3 years, then annually
Treatment-response timingMRI Brain approved every 2 cycles during active chemotherapy and at end of planned chemotherapy
MRI Spine surveillance cadence
MRI Spine surveillance cadenceFor measurable spinal disease: MRI Spine every 2 cycles during induction; surveillance every 3 months for 2 years, then every 6 months for 3 years, then annually
When not indicatedMRI Spine is not medically necessary during surveillance in individuals without prior spinal involvement except for new suspicious symptoms
Peri-treatment imagingMRI Spine every 2 cycles during active therapy for treatment response when spinal disease measurable
Medulloblastoma surveillance schedules
Medulloblastoma surveillance scheduleLow/average-risk: MRI Brain every 3 months for 2 years, then every 6 months for 3 years; MRI Spine every 6 months for 2 years; high-risk spine schedule more frequent as specified
Postoperative timingPostoperative MRI Brain preferably within 48 hours to quantify residual tumor volume; MRI Spine within 28 days if not done pre-op
Treatment-response imaging cadenceMRI Brain and Spine every 2 cycles during active chemotherapy and at end of planned therapy; younger children may require evaluations every 4–6 weeks as indicated
Long-term craniopharyngioma surveillance up to 10 years
Craniopharyngioma long-term surveillanceMRI Brain (70553) every 3 months for 1 year, then every 4 months for 1 year, then every 6 months for 1 year, then annually up to 10 years after therapy
Targeted imaging for suspected recurrenceSuspected recurrence: MRI Brain ± CT Head (70450) and MRI Spine if cord involvement suspected
RationaleLong-term surveillance up to 10 years reflects risk of late progression in craniopharyngioma
PET imaging using radiotracers other than 18F-FDG, 68Ga-DOTATATE, or 68Ga-DOTATOC is considered not medically necessary. PET/MRI is generally not supported and is medically necessary only when PET/CT criteria are met and PET/CT is unavailable or when condition-specific PET/MRI guidance applies; when allowed, PET/MRI must be reported as CPT 78813 plus CPT 76498.
PET/CT is not reliable for lesions smaller than 8 mm, and PET use for surveillance or serial monitoring of FDG avidity is generally excluded except where a diagnosis-specific section explicitly permits it.
For syndromes with documented increased sensitivity to ionizing radiation (e.g., Li-Fraumeni Syndrome), screening strategies that rely on CT or nuclear medicine are not appropriate due to radiation risk; MRI-based approaches and ultrasound are preferred when supported by the syndrome-specific guidance.
Ordering clinicians must document rationale when requesting CT or nuclear studies in radiation-sensitive syndromes; inappropriate use of ionizing radiation for routine screening may be denied.
Asymptomatic imaging has no defined role for Familial Retinoblastoma outside examination under anesthesia (EUA). When imaging is indicated (e.g., retinomas or inconclusive EUA), prefer ultrasound or MRI orbits rather than CT or nuclear imaging to avoid ionizing radiation exposure.
Annual MRI of the orbits (CPT 70543) is the recommended modality for individuals with retinomas; CT and nuclear procedures should be avoided when non-ionizing alternatives are feasible.
For infantile myofibromatosis, whole-body MRI (CPT 76498) may be used once within 6 months of diagnosis to assess for multifocal disease in children under two. Routine surveillance of cutaneous or muscular sites is not supported because most lesions regress spontaneously; surveillance beyond age two years is not supported.
Targeted MRI of symptomatic or surgically relevant sites is medically necessary when clinical indications (symptoms or preoperative planning) exist.
MR Spectroscopy (CPT 76390) and PET Brain metabolic imaging (CPT 78608) are not medically necessary for routine surveillance. They may be medically necessary for specific diagnostic questions—such as distinguishing radiation necrosis from tumor progression within 18 months or characterizing an indeterminate lesion—only when specified in the diagnosis-specific guideline sections.
Requests for PET Brain or MRS must document the histology or the specific clinical decision that will be influenced by the metabolic imaging result.
PET Brain metabolic imaging and MR Spectroscopy are considered not medically necessary for evaluation of certain tumor types including atypical teratoid/rhabdoid tumor (ATRT), pineocytoma, central nervous system germ cell tumors, and ependymal tumors. These modalities have no defined role for those histologies in the guideline and are excluded from coverage for those indications.
Advanced metabolic brain imaging requests for these diagnoses will be denied absent a diagnosis-specific justification specified in the guideline.
PET Brain metabolic imaging and MR Spectroscopy do not have a defined role for craniopharyngioma or choroid plexus tumors and are considered not medically necessary for evaluation of these lesions. Primary management, staging, and surveillance are performed using MRI Brain (CPT 70553) with or without targeted spine imaging as indicated.
When metabolic imaging is requested for these tumor types, prior authorization should align with the guideline; absent a listed exception, PET Brain or MRS requests will be denied.
Apply pediatric sections when condition-specific pediatric guidance exists; otherwise use general guidance
Documentation noteOrdering documentation should reflect age-based routing and indication per guideline
Concurrent supervision (3D rendering)
Concurrent supervision for 3D renderingConcurrent supervision requires active physician participation in and monitoring of 3D post-processing (design, tissue selection, images archived)
Code distinctionsCPT 76376 (no independent workstation) vs CPT 76377 (requires independent workstation) — both require physician supervision
Prior authorization noteProviders may be required to obtain prior authorization for 3D rendering codes even if base imaging does not require prior auth
Imaging guidance procedure codes definition
Definition of imaging guidance procedure codesCodes (e.g., 77011-77022, 76942, 75989) include all imaging necessary to guide needles/catheters and represent radiologic supervision and interpretation
Billing ruleDo not routinely bill a diagnostic procedure code in conjunction with a guidance procedure code; guidance codes capture imaging during the percutaneous procedure
Unlisted code alternativeWhen no anatomic-specific CPT exists for a guidance/procedural study, report appropriate unlisted code (76497/76498) or Category III if available
Unlisted CT/MR/Nuclear procedure codes
Unlisted CT/MR/Nuclear procedure codesCPT 76497 (unlisted CT), CPT 76498 (unlisted MR), CPT 78999 (unlisted diagnostic nuclear medicine) — use when no anatomic-specific code exists
Category III preferenceIf a Category III code describes the procedure, it must be reported instead of an unlisted code when available
Examples of useNeurosurgical navigation (Stealth/Brain Lab), custom arthroplasty planning, or thinner cuts/positional acquisitions for surgical planning
Limited CT (CPT 76380) definition
Limited CT (CPT 76380) definitionCPT 76380 reports limited or follow-up CT where full diagnostic code work is not performed (limited slices/protocols)
Common examplesLimited sinus CT, limited slices for known pulmonary nodule, limited slices for non-healing fracture
Coverage restrictionCPT 76380 is not medically necessary for treatment planning purposes and should not be used to cover 'extra slices' with other diagnostic CT codes
Suspected/Initial Staging definition
Suspected/Initial Staging definitionImaging from time cancer first clinically suspected until treatment initiation; CT chest prior to anesthesia for biopsy/resection usually indicated
Treatment Response definitionImaging during active therapy, generally after every 2 cycles (~6 weeks for solid tumors; ~8–12 weeks for CNS tumors)
Surveillance definitionImaging for asymptomatic or chronically stable individuals not receiving active treatment; PET generally not medically necessary for surveillance unless specified
Treatment Response definition
Treatment Response definition (concise)Imaging after every 2 cycles of therapy to assess response; applies to solid tumors and CNS tumors per specified intervals
Surveillance definition (concise)Asymptomatic follow-up imaging; PET is not routinely medically necessary for surveillance unless diagnosis-specific sections allow
Recurrence definitionImaging when recurrence/progression suspected or documented by clinical signs, labs, or basic imaging; follow initial staging studies for recurrence evaluation
Surveillance definition
Surveillance definition (policy)Imaging in asymptomatic or chronically stable individuals not on active treatment; PET not medically necessary for surveillance unless specified
Recurrence definition (policy)Imaging when recurrence/progression suspected or documented; initial-staging studies are appropriate for documented recurrence
Implication for PETPET/CT generally not authorized for routine surveillance — requires diagnosis-specific allowance
Li-Fraumeni Syndrome (LFS) definition
Li-Fraumeni Syndrome (LFS) definitionAutosomal dominant syndrome with germline TP53 mutations, high lifetime cancer risk and increased radiation sensitivity; specific surveillance schedule provided
Radiation sensitivity noteIndividuals with LFS have increased sensitivity to ionizing radiation; avoid CT/nuclear screening when possible and prefer MRI/US
Surveillance componentsAnnual brain MRI and annual whole-body MRI plus frequent infant abdominal/pelvic ultrasound per guideline
Neurofibromatosis type 1 and 2 (NF1/NF2)
NF1/NF2 definitionAutosomal dominant disorders causing neurocutaneous tumors; NF1 has plexiform neurofibromas and risk of MPNST; NF2 associated with vestibular schwannomas, meningiomas, spinal tumors
Imaging approachSurveillance relies on MRI brain/orbits and MRI spine per age/history; WBMRI may be used once in late adolescence to assess tumor burden
Radiation sensitivityNF1 individuals have increased radiation sensitivity — CT and nuclear imaging not appropriate for routine screening