Pediatric Peripheral Vascular Disease (PVD) Imaging Guidelines

This policy covers pediatric peripheral vascular disease (PVD) imaging, including modality-specific guidelines and procedure codes for common pediatric presentations such as vascular anomalies (lymphatic, venous, capillary, arteriovenous malformations and fistulas), vascular tumors, vasculitis (large/medium/small vessel), and aortic/visceral arterial disorders. It applies to patients ≤18 years, requires documented active signs/symptoms and an appropriate clinical evaluation prior to advanced imaging (asymptomatic screening and most repeat studies are not covered), mandates minimizing anesthesia exposure in young children, restricts contrast when contraindicated, and requires physician review for atypical or unaddressed presentations.

"No other explicit documentation requirements are specified in this excerpt."

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