Pediatric Peripheral Vascular Disease (PVD) Imaging Guidelines

This policy covers pediatric imaging for peripheral vascular disease using advanced vascular modalities (principally MR angiography and CT/CTA, with select nuclear studies) to evaluate suspected PVD in children. It applies to patients <18 with documented active signs or symptoms (not for asymptomatic screening), requires a prior clinical evaluation and basic imaging before advanced studies, limits repeat imaging to cases with documented progression or impact on management, and notes practical restrictions such as gadolinium contraindications, anesthesia needs for young children, and certain PET codes not used in pediatrics.

"Documentation that intravenous access will already be present for anesthesia administration."

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