Criteria
Coverage is subject to the specific terms of the member’s benefit plan.
Off-label applications of chelation therapy or chemical endarterectomy are considered experimental/ investigational because it is not scientifically supported for efficacy or safety and, therefore, is non-covered, including, but not limited to ANY of the following:
- Alzheimer disease; and
- Arthritis; and
- Atherosclerosis; and
- Autism; and
- Coronary artery disease (CAD); and
- Diabetes; and
- Multiple Sclerosis (MS); and
- Peripheral vascular disease (PVD); and
- Rheumatoid arthritis; and
- Secondary prevention in patients with myocardial infarction (MI).
When the chelation or chemical endarterectomy is not covered, all related services are also not covered (e.g., E/M, lab work, infusion services, administration, etc.).
Procedure Codes
| J0600 | J0895 | J3520 | M0300 | S9355 |
