Treatment of Varicose Veins of the Lower Extremities

Medicare covers treatment of symptomatic varicose veins of the lower extremities after failure of a documented 3-month trial of conservative therapy; qualifying symptoms include pain limiting mobility, recurrent superficial phlebitis, non-healing ulceration, bleeding, stasis dermatitis, or refractory dependent edema. Compressive and foam sclerotherapy (as specified), ERFA, and laser ablation are covered when anatomy is suitable (including vein diameter limits and absence of thrombosis/aneurysm/tortuosity), one pre-operative duplex is allowed, intra-operative ultrasound is included in ERFA/laser valuations and not separately billable, and treatments for asymptomatic veins or spider veins/telangiectasias are considered cosmetic and not covered.

"Compressive sclerotherapy is covered for local small-to-medium symptomatic varices, isolated incompetent perforators, or recurrence of symptomatic varices after adequate surgical removal."