CG-MED-05 Ketogenic Diet for Treatment of Intractable Seizures

This policy addresses use of the ketogenic diet (high-fat, low-carbohydrate therapy) for epilepsy. It is covered as medically necessary only for children and adolescents with seizures refractory to antiepileptic medications; all other indications are considered not medically necessary. Coverage is limited to the pediatric/teen population with drug‑resistant seizures and does not extend to adults or non‑seizure conditions.

"The use of a ketogenic diet for children and teenagers with seizures refractory to antiepileptic drugs is consideredmedically necessary."

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