Pediatric Peripheral Vascular Disease (PVD) Imaging Guidelines

This policy covers pediatric peripheral vascular disease imaging — including MRA, CTA, PET, duplex ultrasound and related CPT-coded procedures — for evaluation of vascular anomalies, vasculitis, disorders of the aorta and visceral arteries, and arterial disease of the extremities in patients under 18 years. Major limitations/requirements: advanced imaging is reserved for symptomatic patients with documented active signs/symptoms (not routine screening), generally requires a recent (within 60 days) face-to-face evaluation and physician review for atypical presentations, limits use and repeat dosing of gadolinium-based contrast agents unless necessary, notes some PET codes are not/rarely used in pediatrics, and anticipates anesthesia for young children.

"Imaging for vasculitis in pediatric patients"

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