37785
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
3.83
Facility
$234.14
Non-Facility
$338.02
Documentation Required
- Maintain a complete, legible medical record with patient identification, dates of service, and the legible signature of the responsible physician or non-physician practitioner.
- The submitted medical record must support the selected ICD-10-CM code(s) and the CPT/HCPCS code(s) billed must describe the service performed.
- Documentation must include a plan of care for a 90-day episode that supports evaluation including history, physical exam, CEAP clinical classification, VCSS, and a formal venous duplex scan.
- The plan of care must outline timing of interventions versus routine post-procedure follow-up, list planned treatments (e.g., thermal ablation, sclerotherapy, cyanoacrylate/chemical adhesive, mechanochemical ablation, surgical treatments), and must be supported by complete operative procedure notes.
Key Coverage Criteria
- 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).
- NCF sclerotherapy for other incompetent extremity veins is reported with CPT 36470 or 36471.
- Physician-compounded foam (PCF) sclerotherapy for treatment of incompetent extremity truncal and other incompetent extremity veins is reported with CPT 36470 or 36471.
- Treatment (sclerotherapy, surgical ligation/stripping, ablation) of varicose veins of the lower extremities is appropriate when conservative measures (exercise, leg elevation, weight loss, graduated compression, avoidance of prolonged immobility) have been unsuccessful and symptoms persist.
- 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.
20 Active Policies
A56914 — Billing and Coding: Treatment of Varicose Veins of the Lower Extremities
J05
L34536 — Treatment of Varicose Veins of the Lower Extremities
J05
L38720 — Treatment of Chronic Venous Insufficiency of the Lower Extremities
J09
A58250 — Billing and Coding: Treatment of Chronic Venous Insufficiency of the Lower Extremities
J09
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.