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
J0470
|
J0600
|
J0895
|
J3520
|
M0300
|
S9355
|
