Treatment of Varicose Veins of the Lower Extremities

Interventional treatment (sclerotherapy, surgical, ERFA, laser) of lower-extremity varicose veins is covered only after a documented 3-month trial of conservative therapy has failed and the patient is symptomatic (pain, phlebitis, ulceration, bleeding, stasis dermatitis, or refractory edema). ERFA and laser ablation have additional anatomical requirements (no aneurysm, no thrombosis/tortuosity impairing catheter access, absence of significant peripheral arterial disease, and maximum vein diameters of ≤20 mm for ERFA and ≤30 mm for laser), with one pre-procedural duplex/Doppler allowed and intra-operative ultrasound included in the procedure code (not separately billable). Treatments for asymptomatic varicosities or spider veins/telangiectasis (except when bleeding is present), non–FDA-approved devices, or procedures lacking required documentation will be considered cosmetic/noncovered.

"Failure of a documented 3-month trial of conservative therapy (exercise, leg elevation, weight loss, graduated compression, avoidance of prolonged immobility) AND presence of ≥1 symptoms: pain/achi..."