Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins and Other Symptomatic Venous Disorders

This policy covers sclerotherapy (liquid or foam, including Varithena®) and chemical endovenous ablation with cyanoacrylate adhesives (e.g., VenaSeal™) for treatment of varicose veins and other symptomatic venous disorders—including CEAP C2s or greater, documented venous reflux (e.g., >500 ms with specified vein diameter thresholds), recurrent/symptomatic disease with complications (ulceration, bleeding, superficial thrombophlebitis), or r‑VCSS ≥6. Coverage requires duplex ultrasound assessment (standing when possible) and generally failure of ≥6 weeks of conservative therapy; treatments are excluded when listed contraindications apply (e.g., pregnancy/recent postpartum, allergy to agent, active infection, severe peripheral arterial disease/critical limb ischemia, obliterated deep veins, recent sclerotherapy within 6 weeks, severe venous tortuosity), and retreatment timing limitations (typically 6–8 weeks) must be observed.

"Sclerotherapy using liquid or foam irritants (including Varithena®) to diminish abnormally dilated and symptomatic veins (varicose veins)."