Treatment of Chronic Venous Insufficiency of the Lower Extremities

Invasive treatments for chronic venous insufficiency of the lower extremities are covered when a documented history/physical, CEAP classification, VCSS, and duplex ultrasound confirm reflux (≥500 ms) without deep venous obstruction and when symptoms impair activities of daily living or quality of life. Conservative therapy is generally required prior to invasive procedures unless waived for VCSS ≥6, CEAP C4–C6, hemorrhage, or recurrent superficial thrombophlebitis; specific modalities (UGFS, liquid sclerotherapy, thermal ablation, chemical adhesives, MOCA, surgery, phlebectomy) are appropriate based on CEAP class, vein anatomy, and the documented plan of care for a 90-day episode.

"Invasive procedures are medically reasonable and necessary only when the treating physician documents a history and physical examination, CEAP clinical classification, and revised Venous Clinical S..."