S2202, Echosclerotherapy
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
- Directs readers to consult medical policy SUR701.015 for therapeutic embolization and vessel occlusion when treating pelvic conditions (cross-reference requirement).
- Coding instruction: use CPT 36465 for single truncal vein treated with stabilized microfoam (Varithena) in a leg; use CPT 36466 when more than one truncal vein is treated in the same leg.
- Coding instruction: use CPT 36470 for a single non-truncal vein treated with stabilized microfoam (Varithena) in one leg; use CPT 36471 when more than one such vein is treated in the same leg.
- Coding instruction for perforator ablation: CPT 36475 or 36478 for the first perforator in an extremity; CPT 36476 or 36479 for each additional perforator in that extremity.
Key Coverage Criteria
- Endoluminal radiofrequency ablationorendoluminal laser ablation:
- The following modalities are consideredmedically necessarywhen the criteria below (I, II,andIII) have been met:
- Ablative Modalities:Endoluminal radiofrequency;orEndoluminal laser;and
- Endoluminal radiofrequency;or
- Endoluminal laser;and
- The veins to be treated include one or more of the following:Anterior accessory great saphenous vein (AAGSV) also known as anterior saphenous vein (ASV);orGreat saphenous vein (GSV);orSmall saphenous veins (SSV)and
6 Active Policies
ANTHEM-CG-SURG-119, CG-SURG-119 Treatment of Varicose Veins (Lower Extremities)
BCBSIL-SUR707.016, Varicose Vein Management
BCBSMT-SUR707.016, Varicose Vein Management
BCBSNM-SUR707.016, Varicose Vein Management
CARELON-treatment-of-varicose-veins-and-superficial-venous-insufficiency-2026-01-10, Treatment of Varicose Veins and Superficial Venous Insufficiency
Related Codes
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