Peripheral Nerve and Neuromuscular Disorders (PNND) Imaging Guidelines

This policy covers advanced imaging for peripheral nerve and neuromuscular disorders—including ultrasound, MRI/MRN, CT (when MRI is contraindicated), and nuclear imaging—for evaluation of focal neuropathy, polyneuropathy, brachial and lumbosacral plexopathies, muscle and neuromuscular disorders, peripheral nerve sheath tumors (PNST), and related conditions (e.g., POEMS, TOS). Advanced imaging is authorized only after a pertinent clinical evaluation (history and neurologic exam, appropriate labs, non‑advanced imaging, and EMG/NCV unless waived/ deferred in select early cases or replaced by documented meaningful technological contact); ultrasound is preferred for superficial nerves, MRI for deep or bone‑obscured nerves and surgical planning, and atypical presentations require physician review.

"Documented concern specifically for pudendal entrapment"

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