Pediatric Peripheral Nerve Disorders PND Imaging Guidelines

This policy covers advanced imaging for pediatric peripheral nerve disorders—including MRI (extremity/joint with/without contrast and unlisted MRI codes), MRA, PET, nuclear medicine and related musculoskeletal imaging procedures—used to evaluate symptoms addressed by the Pediatric PND Imaging Tool. It applies to pediatric patients with conditions such as neurofibromatosis, brachial plexus disorders and Gaucher disease, but requires documented active clinical signs/symptoms (not for asymptomatic screening), a recent (≤60 days) detailed evaluation before imaging, directs patients <18 to the pediatric guidelines (with older patients managed per adult guidelines), and notes certain PET/MRI codes are rarely used or not applicable in pediatrics and atypical presentations need physician review.

"This tool addresses common symptoms and symptom complexes."

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