Chelation Therapy (CPB 0234, reviewed 2026-02-11)

By February 11, 2026: Billing and authorization teams must implement the following changes: (1) Require prior authorization for ALL deferoxamine mesylate claims; (2) For initial approval, verify claims include evidence of specialist prescription (hematologist or nephrologist) AND one of three qualifying conditions: serum ferritin >1000 mcg/L for transfusional iron overload, aluminum toxicity in dialysis patients, or hereditary hemochromatosis with documented phlebotomy contraindication; (3) For continuation of therapy, require documentation of clinical benefit (decreased ferritin levels, decreased aluminum levels, or symptomatic improvement); (4) Deny all other chelation therapy requests as experimental/investigational, including those for cardiovascular disease, neurodegeneration, autism, and dental amalgam detoxification. Update denial templates in billing system to cite experimental status. Flag all chelation therapy claims without specialist credentials for manual review. Train prior auth staff on the three covered indications and required documentation elements. Failure to follow criteria will result in claim denials and member appeals.