Treatment of Varicose Veins of the Lower Extremities

Medicare covers invasive and non-invasive treatments for chronic venous disorders of the lower extremities when documentation includes history, physical exam, CEAP clinical classification, and venous duplex demonstrating reflux (>500 ms). Specific treatments (liquid/foam sclerotherapy, UGFS, RFA/EVLA, chemical adhesive, MOCA, and surgery) are reasonable and necessary for appropriate anatomic targets (GSV, SSV, accessory saphenous, perforators) when CEAP C2–C6 disease and qualifying symptoms/signs are present; strict criteria apply for incompetent perforator vein treatment (reflux >500 ms, IPV ≥3.5 mm, active ulcer, and proximity to ulcer). Cosmetic disease (CEAP C0 and most C1) and several contraindications (acute DVT, severe distal arterial disease, pregnancy, sclerosant allergy, non-FDA-approved equipment) are excluded from coverage.

"Invasive procedures for varicose veins are reasonable and necessary when the medical record documents a history, physical examination, CEAP clinical classification, and a venous duplex scan demonst..."