Adult Head
Pediatric Head
Adult PND
Pediatric PND
100

The guideline you would go to for a request for MRA Head wo for autosomal dominant polycystic kidney disease for an adult member.

What is HD-12.1, Intracranial Aneurysms?

100

The guideline you would apply for a suspected vein of Galen malformation.

What is PEDHD-10.2, Pediatric Intracranial Arteriovenous Malformations (AVM)?

100

This guideline should be applied for suspected Piriformis Syndrome.

What is PN-2, Focal Neuropathy?

100

This guideline should be used for a member with multiple cutaneous neurofibromas and a diagnosis of NF1.

What is PEDPN-2.1, Neurofibromatosis 1?

200

The guideline you would use to review for intraoperative planning with Stealth navigation.

What is HD-24.1, Treatment Planning?

200

The guideline that would give you an approval for a CT Head wo after a minor head injury 1 week ago followed by continued headaches.

What is PEDHD-3, Pediatric Headache?

200

This guideline should be used when previous imaging reveals a possible schwannoma.

What is PN-9, Peripheral Nerve Sheath Tumors?

200

This guideline should be used for a member with an acoustic neuroma and a diagnosis of NF2?

What is PEDPN-2.2, Neurofibromatosis 2?

300

This guideline could be applied for suspected venous sinus thrombosis to approve an MRA Neck wwo?

What is HD-21.1, Stroke/TIA?
300

This guideline should be applied for a member with sensorineural hearing loss (SNHL) on exam and the rule out of acoustic neuroma.

What is PEDHD-16.1, Hearing Loss?

300

This guideline should be used for a request for an MRN for preoperative planning.

What is PN-7, Magnetic Resonance Neurography?

300

This guideline should be used for suspected brachial plexopathy caused by birth trauma.

What is PEDPN-3, Brachial Plexus?

400

This guideline could be applied for a request for post-operative imaging after resection of a vestibular schwannoma.

What is HD-33.1, Acoustic Neuroma and Other Cerebellopontine Angle Tumors?

400

This guideline could be applied for an abnormality on the neurological exam described as the tongue not being midline when asked to thrust the tongue forward.

What is PEDHD-23, Cranial Neuropathies for hypoglossal nerve palsy on exam?

400

This guideline should be applied for progressive motor weakness and  a combination of upper and lower motor neuron findings on exam. The rule out is Lou Gehrig's disease.

What is PN-8, Amyotrophic Lateral Sclerosis?

400

This guideline should be used when the member is said to have a genetic disorder (GD) that has caused a build up of glucocerebroside in multiple organs.

What is PEDPN-4, Gaucher Disease?
500

The guideline you would apply for the rule out encephalitis with symptoms of vomiting and neck stiffness.

What is HD-14.1, CNS infection?
500

The guideline you would apply for imaging requested for an encephalocele found at birth.

What is PEDHD-30, Scalp and Skull Lesions?

500

This guideline should be applied for suspected dermatomyositis.

What is PN-6.2, Inflammatory Muscle Diseases?

500

This guideline should be used if the request is for cancer screening in a member with known NF2.

What is PEDONC-2.3, Neurofibromatosis 1 and 2?