Pediatric Peripheral Nerve and Neuromuscular Disorders (PNND) Imaging Guidelines

This policy covers imaging for pediatric peripheral nerve and neuromuscular disorders, specifying MRI studies (neck, cervical/thoracic/lumbar spine, brachial plexus, chest, abdomen/pelvis, extremities — various CPT codes), with related guidance on EMG/NCS and select nuclear/PET imaging. It applies to children with symptoms or symptom complexes suggestive of PNND and requires a pertinent clinical evaluation (detailed history, neurologic exam, basic labs/imaging) before advanced imaging; EMG may be limited or non-diagnostic in infants and early post‑injury, screening asymptomatic individuals and routine repeat imaging without evidence of progression/new findings is not supported, and atypical presentations require physician review.

"MRI Lower Extremity Other Than Joint with contrast (rarely used) — CPT 73719"

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