Pediatric Peripheral Nerve Disorders (PND) Imaging Guidelines

This policy covers imaging for pediatric peripheral nerve disorders (CT, MRI, nuclear studies) for children <18, including conditions such as neurofibromatosis, brachial plexus disorders, Gaucher disease, and spinal muscular atrophy. Advanced imaging is limited to patients with documented active signs or symptoms and generally requires a prior pertinent clinical evaluation (detailed history, neurologic exam, labs, and basic imaging such as radiography or ultrasound), with scheduled surveillance as an exception; atypical presentations require physician review and routine screening or repeat imaging is not supported unless it will change management.

"This tool addresses common symptoms and symptom complexes."

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