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TRICARE Policy Manual 6010.60-M, April 1, 2015
Medicine
Chapter 7
Section 2.6
Chelation Therapy
Issue Date:  October 12, 1984
Authority:  32 CFR 199.4(c)(2)(iii), (d)(3)(vi), and (g)(15)
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  C-1, March 10, 2017
1.0  CPT PROCEDURE CODE
90784
2.0  DESCRIPTION
Chelation techniques for the therapeutic or preventive effects of removing unwanted metal ions from the body.
3.0  POLICY
Chelation therapy is covered if the chelator is U.S. Food and Drug Administration (FDA) approved and the therapy is for an FDA approved indication.
4.0  EXCLUSIONS
Chelation therapy (or chemical endarterectomy) is considered an unproven therapeutic modality for the treatment of the following conditions, and is not covered:
•  Multiple sclerosis
•  Arthritis
•  Hypoglycemia
•  Diabetes
•  Arteriosclerosis
•  Malaria
•  Cancer
•  Alzheimer’s disease
•  Autism spectrum disorders
•  Other off-label uses of FDA approved chelating agents.
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