Peripheral Nerve Disorders (PND) Imaging Guidelines

This policy covers imaging for peripheral nerve disorders, including focal and polyneuropathies, brachial and lumbosacral plexopathies, neuromuscular and muscle disorders, peripheral nerve sheath tumors, MR neurography, and related nuclear imaging. Imaging is permitted only after a pertinent clinical evaluation (history, neurological exam, appropriate labs, non‑advanced imaging and typically EMG/NCV—which may be waived during the COVID‑19 pandemic or considered case‑by‑case early in disease); ultrasound is preferred for superficial nerves, MRI for deep or bone‑obscured nerves and surgical planning, CT only if MRI is contraindicated, and atypical presentations require physician review.

"Reference; and individual use, only limited to facilitating the determination of medically necessary and appropriate clinical treatment by clinicians for specific delegated patients under their care."