Peripheral Nerve Disorders (PND) Imaging Guidelines

This policy covers imaging for peripheral nerve disorders—including ultrasound, MRI/MRN, CT, and nuclear imaging—to evaluate focal neuropathies, polyneuropathy, brachial and lumbosacral plexopathies, neuromuscular/muscle disorders, and peripheral nerve sheath tumors. Advanced imaging is allowed only after a pertinent history and neurological exam since symptom onset/change, appropriate labs/non‑advanced imaging and typically EMG/NCV (which may be waived early after onset or during the COVID‑19 pandemic at the treating clinician’s discretion); ultrasound is preferred for superficial nerves, CT is limited to MRI‑contraindicated cases, and specific MRI restrictions apply for carpal tunnel and ulnar neuropathy.

"Documented concern specifically for pudendal entrapment: MRI Pelvis without contrast (CPT® 72195) OR MRI Pelvis without and with contrast (CPT® 72197)."

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