Peripheral Vascular Disease (PVD) Imaging Guidelines

This policy covers diagnostic imaging for peripheral vascular disease, including arterial and venous studies (ABI/TBI, duplex ultrasound, CTA/MRA runoff, nuclear medicine and other vascular imaging) for evaluation of PAD, aneurysmal disease, cerebrovascular/carotid disease, pulmonary hypertension, aortic/renal/visceral disorders, hemodialysis access, AVMs, acute and chronic limb swelling, IVC filters, post-stent assessment, and related conditions. Major requirements/limitations: advanced imaging is only considered after a pertinent clinical evaluation or meaningful technological contact, ABI should be measured first with recent ABI (within 60 days) required for symptoms, exercise ABI or TBI are reserved for specific indications (persistent high suspicion or non‑compressible arteries/CLI), repeat studies are generally discouraged unless clinical change or indeterminate prior testing, and atypical presentations require physician review and additional justification.