36299
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Each claim must be submitted with ICD-10-CM code(s) that reflect the patient's condition and indicate the reason(s) the service was performed.
- The medical record must contain a history and physical examination supporting the diagnosis of symptomatic varicose veins and the documented failure of an adequate (≥3 months) trial of conservative management.
- The medical record must document performance of appropriate diagnostic tests, if medically necessary, to confirm the pathology of the vascular anatomy.
- All documentation supporting the claim must be made available to Medicare upon request.
Key Coverage Criteria
- Treatment of symptomatic varicose veins of the lower extremities is covered when the medical record documents symptomatic varicose veins and failure of an adequate conservative management trial of at least 3 months.
- Treatment of symptomatic varicose veins of the lower extremities caused by venous insufficiency as a result of valve reflux (dilated, tortuous, superficial vessels).
- Surgical treatment (e.g., venous ligation, vein stripping and/or sclerotherapy) when: a 3-month trial of conservative therapy (exercise, periodic leg elevation, weight loss, compressive therapy, avoidance of prolonged immobility where appropriate) has failed, AND the patient is symptomatic with one or more of: pain or burning in the extremity severe enough to impair mobility; recurrent episodes of superficial phlebitis; non-healing skin ulceration; bleeding from a varicosity; stasis dermatitis; [...]
- Compressive sclerotherapy for local small to medium symptomatic varices, isolated incompetent perforators, or recurrence of symptomatic varices after adequate surgical removal of varices.
- Foam sclerotherapy (noted FDA indication): treatment of incompetent great saphenous veins (GSV), accessory saphenous veins and visible varicosities of the GSV system above and below the knee (usually performed with ultrasound guidance).
- Endoluminal radiofrequency ablation (ERFA) or endoluminal laser ablation for symptomatic varicosities of the greater or lesser saphenous veins and their tributaries that have failed a 3-month trial of conservative therapy, provided the patient's anatomy and clinical condition are amenable to the proposed treatment and all anatomic/clinical criteria are met.
4 Active Policies
A57706 — Billing and Coding: Treatment of Varicose Veins of the Lower Extremities
L34209 — Treatment of Varicose Veins of the Lower Extremities
L34010 — Treatment of Varicose Veins of the Lower Extremities
A57707 — Billing and Coding: Treatment of Varicose Veins of the Lower Extremities
Related Codes
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