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Anthem Blue Cross Connecticut CG-MED-05 Ketogenic Diet for Treatment of Intractable Seizures Form
This procedure is not covered
This document addresses the use of a ketogenic diet to assist in the treatment of seizures.
Clinical Indications
Medically Necessary:
The use of a ketogenic diet for children and teenagers with seizures refractory to antiepileptic drugs is considered medically necessary.
Not Medically Necessary:
The use of a ketogenic diet for all other indications is considered not medically necessary.