We’ve updated our chelation therapy medical and billing policies to align coverage criteria and claims processing requirements. These changes apply to all plans.
Expanded diagnosis list
We’ve updated medical policy #91077 – Chelation Therapy to include additional diagnosis codes that may support the use of chelation therapy.
New claims requirements
- Professional claims: Claim edits are already in place for professional claims to ensure submitted diagnoses align with our medical policy criteria. Effective immediately, the expanded diagnosis codes outlined in medical policy #91077 will be included in those edits.
- Facility claims: Effective Sept. 7, 2026, we’ll implement claim edits for facility claims to ensure submitted diagnoses align with medical policy #91077 criteria. Claims submitted without an appropriate diagnosis code may be denied. See billing policy #159 – Chelation Therapy for billing requirements and details.