Does S9355 require prior authorization?

No, S9355 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

What is the Medicare reimbursement rate for S9355?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`S9355`, Home infusion therapy, chelation therapy; administrative services, professional

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

None specified in this policy. (The CPB does not list required medical records, test results, or other documentation for coverage because the services are considered experimental/investigational and not covered.)
Documentation that the individual meets DSM-5 TR criteria for Autism Spectrum Disorder when behavioral health treatment is requested

Key Coverage Criteria

Chelation therapy is covered as medically necessary for heavy metal toxicity and overload conditions (e.g., iron, copper, lead, aluminum).
Aetna considers the use of devices to image the jawbones to diagnose NICO or NICO-type conditions experimental and investigational.
None. The policy states that surgery, other therapies, bone graft replacement, and devices to image the jawbones (including ultrasonograph bone densitometer) for diagnosis or treatment of neuralgia inducing cavitational osteonecrosis (NICO) or NICO-type conditions are considered experimental and investigational and therefore are not covered.
Behavioral health evaluation including psychiatric examination for suspected or known ASD
Electroencephalogram (EEG) when there is suspicion of a seizure
Evaluation by speech and language pathologist

10 Active Policies

ANTHEM-CG-MED-90, Chelation Therapy

UHC-POL-chelation-therapy-non-overload-conditions, Chelation Therapy

AETNA-CPB-0642, Neuralgia Inducing Cavitational Osteonecrosis (NICO) and Ultrasonograph Bone Densitometer to Detect NICO

BCBSIL-THE801.008, Chelation Therapy for Off-Label Uses

BCBSMT-THE801.008, Chelation Therapy for Off-Label Uses

BCBSNM-THE801.008, Chelation Therapy for Off-Label Uses

BCBSOK-THE801.008, Chelation Therapy for Off-Label Uses

UMR-POL-UMR-chelation-therapy-non-overload-conditions, Chelation Therapy

SUREST-POL-SUREST-chelation-therapy-non-overload-conditions, Chelation Therapy

CIGNA-0447, Autism Spectrum Disorders/Pervasive Developmental Disorders: Assessment and Treatment

`S9355`, Home infusion therapy, chelation therapy; administrative services, professional

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

10 Active Policies

Related Codes

Have a follow-up question?

S9355, Home infusion therapy, chelation therapy; administrative services, professional

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

10 Active Policies

Related Codes

Have a follow-up question?

`S9355`, Home infusion therapy, chelation therapy; administrative services, professional