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DESCRIPTIONIntravenous therapy (IV therapy) is the administration of liquid solutions directly into a vein. In the case of IV nutrient therapy, vitamins, minerals, and amino acids are infused directly into the bloodstream rather than absorbed through the stomach after being routed through the digestive system. IV nutrient therapy is offered in alternative and homeopathic providers’ offices and in spa settings. It is administered as anti-aging therapy for skin rejuvenation, to boost circulation and metabolism, increase energy, vitality, memory, and concentration while eliminating toxins (blood detoxification) that cause fatigue and unhealthiness.
There is no data published in peer-reviewed scientific literature, criteria developed by specialty societies, or guidelines adopted by other health care organizations that support the medical efficacy of intravenous nutrient therapy; therefore, it is not considered accepted medical practice.
POLICYIntravenous nutrient therapy is considered not medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
05/01/2013: New policy added. Approved by Medical Policy Advisory Committee.
07/30/2015: Code Reference section updated for ICD-10.
06/06/2016: Policy number L.2.01.407 added. Investigative definition updated in Policy Guidelines section.
SOURCE(S)American College of Physicians PIER (Physicians' Information and Education Resource)
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
Not Medically Necessary Codes
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