Peripheral Nerve Disorder (PND) Imaging Guidelines

This policy covers advanced imaging of the peripheral nervous system (MRI, ultrasound, CT and nuclear imaging) for evaluation of peripheral nerve disorders including focal and polyneuropathies, brachial and lumbosacral plexopathies, muscle disorders, ALS, and peripheral nerve sheath tumors. Advanced imaging requires a current clinical evaluation within 60 days (relevant history/neurologic exam, labs, nonadvanced imaging and EMG/NCV as applicable), MRI is generally preferred to CT, and atypical presentations or requests not addressed by the tool—as well as routine imaging for conditions like uncomplicated carpal tunnel or non‑severe ulnar neuropathy—are limited and require physician review or additional justification.

"Ultrasonography in peripheral nervous system diagnosis."

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