Anthem Blue Cross Connecticut CG-MED-05 Ketogenic Diet for Treatment of Intractable Seizures Form

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.