36468
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
- Claims submitted without a valid ICD-10-CM diagnosis code will be returned as incomplete; the diagnosis code must best describe the patient's condition for the service performed.
- The patient's medical record must contain documentation fully supporting medical necessity including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
- Medical record must document history and physical findings supporting a diagnosis of symptomatic varicose veins.
- Medical record must document failure of an adequate trial of conservative treatment as described in the LCD.
Key Coverage Criteria
- Interventional treatments are covered for symptomatic varicose veins of the lower extremity when the medical record documents history and physical findings supporting the diagnosis.
- Coverage requires failure of an adequate trial of conservative treatment prior to interventional therapy as described in the LCD.
- Coverage requires exclusion of other causes of limb edema, ulceration, and pain prior to treatment of varicose veins.
- Coverage requires performance of appropriate diagnostic testing (e.g., duplex ultrasound) to confirm the presence and location of incompetent perforating veins when indicated.
- Injection sclerotherapy (CPT 36468) is appropriate for treatment of symptomatic spider veins / telangiectasia of the lower extremities.
- Non-compounded foam (NCF) sclerotherapy is appropriate for treatment of incompetent extremity truncal veins (report with CPT 36465 or 36466).
20 Active Policies
L34536 — Treatment of Varicose Veins of the Lower Extremities
J05
A56914 — Billing and Coding: Treatment of Varicose Veins of the Lower Extremities
J05
A52870 — Billing and Coding: Treatment of Varicose Veins of the Lower Extremity
J06
L33575 — Varicose Veins of the Lower Extremity, Treatment of
J06
Related Codes
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