CMSNational Coverage Determination (NCD)

Dimethyl Sulfoxide (DMSO) Form

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Dimethyl Sulfoxide (DMSO)

Notes: The FDA approves DMSO for interstitial cystitis only. Use of DMSO for any other condition is not considered reasonable and necessary, and therefore not covered.

Indications

(819280) Is the Dimethyl Sulfoxide (DMSO) being used for the treatment of interstitial cystitis? 

Contraindications

(819281) Is Dimethyl Sulfoxide (DMSO) being used for any purpose other than the treatment of interstitial cystitis? 
Effective Date

01/01/2066

Last Reviewed

NA

Original Document

  Reference



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.

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