Peripheral Nerve Disorder (PND) Imaging Guidelines

This policy covers advanced imaging (primarily MRI, with selective use of ultrasound, CT, and nuclear techniques) for evaluation of peripheral nerve disorders, including focal and polyneuropathies, brachial and lumbosacral plexus disorders, muscle disorders, ALS, and peripheral nerve sheath tumors. Imaging requires a recent clinical evaluation (within 60 days) and appropriate prior workup (history/physical, labs, non‑advanced imaging, and usually EMG/NCV), atypical presentations need physician review, MRI is preferred over CT, and specific limits include no routine advanced imaging for carpal tunnel (wrist ultrasound only pre‑op if EMG equivocal), MRI for ulnar neuropathy limited to pre‑operative use, and MRI for radial neuropathy limited to severe/surgical or tumor‑suspected cases.

"Radiation plexopathy to r/o malignant infiltration"

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