Pediatric Peripheral Vascular Disease (PVD) Imaging Guidelines

This policy covers pediatric peripheral vascular disease (PVD) imaging across modalities (e.g., MRA, CTA, duplex ultrasound, and select PET/PET‑CT codes) for evaluation of vascular anomalies, vasculitis, disorders of the aorta and visceral arteries, and other common pediatric PVD symptom complexes. It applies to patients <18 years (with adult guidelines for ≥18), requires a recent (≤60 days) face‑to‑face evaluation before advanced imaging, limits imaging to symptomatic patients with condition‑specific contrast use, restricts routine or repeat studies absent documented progression or management impact, notes certain PET codes are not used or rarely used in pediatrics, and atypical presentations require physician review (with anesthesia considerations for young children).

"A recent (within 60 days) face to face evaluation including a detailed history, physical examination, and appropriate laboratory studies should be performed prior to considering advanced imaging (C..."