Dimethyl Sulfoxide (DMSO)

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.

"DMSO is covered only for the treatment of interstitial cystitis when its use is reasonable and necessary for the patient."

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