Peripheral Vascular Disease (PVD) Imaging Guidelines

This policy covers imaging guidelines for peripheral vascular disease (PVD), including use of ultrasound, CTA, MRA, and nuclear studies for a wide range of conditions such as peripheral artery disease, aneurysmal disease, cerebrovascular/carotid disease, upper and lower extremity PVD, pulmonary arterial hypertension, aortic/renal/visceral vascular disorders, hemodialysis access evaluation, AVMs, venous thrombotic and chronic venous disease, and IVC filter assessment. Major limitations/requirements include prior pertinent clinical evaluation and meaningful clinician contact before advanced imaging, reliance on ABI testing (exercise ABI only if resting ABI is normal but suspicion remains; TBI for non-compressible arteries), recent ABI availability (generally within 60 days of symptom onset/worsening), physician review for atypical presentations, and repeat studies only for clinical change or indeterminate prior imaging.

"Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral."