NCDActive
Dimethyl Sulfoxide (DMSO)
NCD149
Effective: January 1, 1966
Updated: December 31, 2025
Policy Summary
DMSO is covered only when used to treat interstitial cystitis and only when its use is reasonable and necessary for the patient. Use of DMSO for any other condition is not covered. The policy does not specify additional documentation or frequency limits beyond standard medical necessity documentation.
Coverage Criteria Preview
Key requirements from the full policy
"DMSO is covered only for the treatment of interstitial cystitis when its use is reasonable and necessary for the patient."
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Covered Medical Codes