Treatment of Chronic Venous Insufficiency of the Lower Extremities

Invasive treatments for chronic venous insufficiency of the lower extremities are covered when a documented 90-day plan of care includes history and physical, CEAP classification, VCSS, and a venous duplex scan confirming reflux (≥500 ms) and absence of deep venous obstruction, with symptoms that impair ADLs or quality of life. CEAP C2–C6 symptomatic disease warrants procedures such as sclerotherapy, thermal ablation, chemical adhesive, MOCA, or surgery; CEAP C1 and C0 treatments are generally considered cosmetic and not covered except for spontaneous or traumatic venous hemorrhage (C1). Conservative therapy should be attempted prior to invasive procedures unless specific waiver criteria are met (e.g., VCSS ≥6, C4–C6, hemorrhage, recurrent superficial thrombophlebitis).

"Invasive procedures are medically reasonable and necessary only when ALL of the following are documented: history and physical exam, CEAP clinical classification, and revised Venous Clinical Severi..."