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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.
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered 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.
05/01/2013: New policy added. Approved by Medical Policy Advisory Committee.
07/30/2015: Code Reference section updated for ICD-10.
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