Pediatric Peripheral Nerve Disorders (PND) Imaging Guidelines

This policy covers pediatric imaging for peripheral nerve disorders—primarily MRI protocols (neck, cervical, thoracic, brachial plexus, chest, lumbar, etc., with associated CPT codes) for conditions such as neurofibromatosis, brachial plexus disorders, Gaucher disease and other pediatric peripheral nerve disorders. Imaging is limited to patients with documented active signs/symptoms and generally requires a recent (≤60 days) face‑to‑face neurologic evaluation, excludes routine screening of asymptomatic patients, requires physician review for atypical presentations, prefers MRI with and without gadolinium unless contraindicated, limits repeat studies to progression/new disease or management‑changing findings, and notes infants <7 usually need anesthesia (patients ≥18 follow adult guidelines).

"Brachial plexus MRI without contrast (bilateral) — 71550"

Sign up to see full coverage criteria, indications, and limitations.