January 28, 2003

Bruce Shelton, M.D.
14231 North 7th Street
Phoenix, AZ 85022

RP: Chelation Therapy

Dear Doctor Shelton:

We have reviewed your letter regarding Chelation Therapy. Our current Medical Coverage
Guidelines are as follows:

Chelation therapy is considered medically necessary for the treatment of documented toxicity for the following indications:

Arsenic poisoning
Gold poisoning
Iron intoxication, acute
Iron overload, chronic
Lead Poisoning; acute and chronic
Mercury poisoning, acute
Cystinuria
Potentially life-threatening digoxin intoxication
Potentially life-threatening digitoxin overdose
Hypercalcemia, emergency treatment
Rheumatoid arthritis, severe and active disease that has not responded to     Conventional therapy
Ventricular arrythmias associated with digitalis toxicity
Wilson's disease in persons not tolerant of penicillamine

Chelation therapy is considered investigational based upon insufficient scientific evidence to permit conclusions concerning the effect on health outcomes for treatment of the following indications, including, but not limited to:

Arteriosclerosis
Arthritis (other than described under guideline)
Diabetes
Hypoglycemia
Multiple Sclerosis
Or any condition not listed under guideline under Medically necessary

Our Medical Policy Department protocol is to perform a literature review on a coverage guideline every two years. The chelation therapy guideline will be given consideration later this year. If you have any peer-reviewed literature extracted from current clinical publications supporting the efficacy of chelation for the currently indicated investigational conditions, we would be happy to receive and review it.

I hope this information is helpful to you. If you wish to send in literature that falls within the parameters indicated above, please send it to the attention of the Medical Policy Department.

If you have any questions, please contact the current Network Contract specialist for your office, Diana Bishop at 602-864-4671.

Sincerely,

Connie Sordahl
Network contact Specialist

cc: Provider Files

Phone: 602-864-4028
Fax: 602-684-4224
E-mail: Csordahl@phx1.bcbsaz.com
Address: Network Relations, Mail Stop A212
              P.O. Box 13466
              Phoenix, AZ 85002-3466

Post Office Box 13466 • Phoenix, AZ 85002-3466 2444 West Las Palmariras Drive • Phoenix, AZ 85021-4883 • (602) 864-4400 • www.bcbsaz.com