CMS Dimethyl Sulfoxide (DMSO) Form
This procedure is not covered
Background for this Policy
DMSO is an industrial solvent produced as a chemical byproduct of paper production from wood pulp.
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.