Pediatric Peripheral Nerve Disorders (PND) Imaging Guidelines

This policy covers pediatric peripheral nerve disorder imaging—primarily advanced MRI (typically without and with contrast) of the neck, cervical/thoracic spine, brachial plexus and related regions—for evaluation and surveillance of common symptom complexes and specific pediatric conditions such as neurofibromatosis, brachial plexus injury, Gaucher disease, and spinal muscular atrophy in individuals <18 years. Major requirements and limitations: advanced imaging generally requires a detailed history, neurologic exam, basic imaging/labs (except for guideline‑scheduled surveillance), atypical presentations need physician review, anesthesia is usually required for infants/young children, PET is not used in pediatrics, and repeat imaging is discouraged unless it will affect management; patients ≥18 follow adult guidelines.

"PET Imaging CPT codes 78811, 78812, 78813 are noted as 'this code not used in pediatrics' (i."