About this policy
CMS National Coverage Determination | ncd_id=149 | manual_section=230.12 | coverage_level_code=2 | national_coverage_type=True | under_review=False | lab_ncd=False
Coverage indications
The Food and Drug Administration has determined that the only purpose for which DMSO is safe and effective for humans is in the treatment of the bladder condition, interstitial cystitis. Therefore, the use of DMSO for all other indications is not considered to be reasonable and necessary. Payment may be made for its use only when reasonable and necessary for a patient in the treatment of interstitial cystitis.
Documentation requirements
Item/Service Description: DMSO is an industrial solvent produced as a chemical byproduct of paper production from wood pulp. Benefit Categories: 22 - Drugs and Biologicals
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
Backwork has no codes on record for this policy. Check the source.