Chelation Therapy for Treatment of Atherosclerosis — NCD 86 | CMS Coverage Update

CMS modified NCD 86, the National Coverage Determination governing chelation therapy for atherosclerosis, effective March 7, 2026. Here's what billing teams need to know.

The Centers for Medicare & Medicaid Services updated NCD 86, its coverage policy for EDTA chelation therapy used in the treatment or prevention of atherosclerosis. The policy reaffirms that this therapy is not covered under Medicare — and it goes further than a simple denial by explicitly addressing variant terminology that some practitioners use on claims. The policy does not list specific CPT or HCPCS codes. If your billing team submits claims for chelation therapy under any diagnosis or procedure label, this policy applies.

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Quick-Reference Table

Field	Detail Copy
Payer	CMS
Policy	Chelation Therapy for Treatment of Atherosclerosis
Policy Code	NCD 86
Change Type	Modified
Effective Date	2026-03-07
Impact Level	High
Specialties Affected	Cardiology, Internal Medicine, Integrative Medicine, Naturopathic Medicine, Vascular Surgery
Key Action	Deny and do not bill Medicare for EDTA chelation therapy for atherosclerosis or any variant diagnosis — including arteriosclerosis and calcinosis.

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CMS Chelation Therapy Coverage Criteria and Medical Necessity Requirements 2026

The CMS chelation therapy coverage policy under NCD 86 is unambiguous: EDTA chelation therapy for the treatment or prevention of atherosclerosis does not meet medical necessity requirements under Medicare. Full stop.

CMS cites three reasons. First, there is no widely accepted clinical rationale explaining how this therapy produces beneficial effects. Second, its safety record is questioned. Third, no well-designed, controlled clinical trials have established its effectiveness.

Because it fails medical necessity on all three grounds, this therapy is classified as experimental. That classification is not a technicality — it's the mechanism that triggers a blanket denial on any related claim.

Prior authorization is not part of this equation. This is not a service that requires prior auth before billing — it is a non-covered service, period. No amount of prior authorization documentation will make EDTA chelation therapy for atherosclerosis reimbursable under Medicare.

The effective date of March 7, 2026 makes this the governing standard for any claims processed on or after that date. If your team has been submitting these claims and receiving payment, that revenue is at risk of recoupment.

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CMS EDTA Chelation Therapy Exclusions and Non-Covered Indications

This is where NCD 86 gets specific — and where billing teams often get caught.

CMS explicitly anticipates that some practitioners will disguise chelation therapy claims by using alternate terminology. The policy names three variant terms directly: chemoendarterectomy, arteriosclerosis, and calcinosis. Claims using any of these terms to describe what is functionally EDTA chelation therapy for atherosclerosis must also be denied.

This is not a gray area. CMS states that claims "employing such variant terms should also be denied under this section." Your Medicare Administrative Contractor will apply that instruction consistently.

The real issue here is that this provision exists because some providers have historically used these alternate terms to move claims past automated edits. CMS is closing that path. If your billing team processes claims from providers who use "chemoendarterectomy" as the procedure descriptor, or who code arteriosclerosis or calcinosis as the primary diagnosis to justify chelation, those claims are non-covered under the same policy.

This also matters for any practice that bills "incident to" a physician's professional service. The policy's benefit category includes both incident-to services and physicians' services. Chelation therapy billing in either context falls under this NCD.

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Coverage Indications at a Glance

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CMS Chelation Therapy Billing Guidelines and Action Items 2026

These are specific steps your billing team should take now — not after the next denial hits.

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Chelation Therapy Under NCD 86

Covered CPT Codes

NCD 86 does not identify any CPT or HCPCS codes as covered for chelation therapy related to atherosclerosis. There are no covered codes under this policy.

Not Covered / Experimental

The policy does not list specific CPT or HCPCS codes. CMS instead describes the service and its variant terminology in prose. This approach means claim denials under NCD 86 are applied based on the nature of the service — not a specific code trigger.

What this means for chelation therapy billing: Your MAC will apply NCD 86 to claims it identifies as EDTA chelation therapy for atherosclerosis, regardless of which procedure code your team uses. The absence of code-level specificity in NCD 86 is not a loophole. It is a deliberate design that prevents billing teams from simply switching codes to avoid denial.

If you are unsure which codes your organization uses for chelation-related infusion services, pull a utilization report filtered by the relevant ICD-10-CM diagnosis codes for atherosclerosis (I70.x series), arteriosclerosis, and calcinosis. Cross-reference those claims against any infusion procedure codes. That intersection is your exposure.

Key ICD-10-CM Diagnosis Codes to Monitor

NCD 86 does not formally list ICD-10-CM codes, but the policy explicitly names these clinical conditions as triggers for denial:

Condition Named in NCD 86	Relevant ICD-10-CM Range to Monitor Copy
Atherosclerosis	I70.x (Atherosclerosis)
Arteriosclerosis	I70.x (overlaps with atherosclerosis)
Calcinosis	M61.x (Calcification and ossification of muscle) / E83.5x (Disorders of calcium metabolism)

These are not codes CMS has officially listed in the NCD — they are diagnostic categories you should use to identify potentially non-covered claims in your system. Confirm your specific ICD-10 mapping with your coding team or compliance officer.

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