Varicose Vein Management

This policy covers interventional and surgical treatment of varicose veins—including high ligation/stripping, SEPS, endovenous radiofrequency or laser ablation (ERFA/EVLA), truncal cyanoacrylate (VenaSeal), stabilized microfoam (Varithena), sclerotherapy, and phlebectomy/stab avulsion—when used to treat symptomatic varicose vein insufficiency of the great/small saphenous, duplicate/ accessory, and perforator veins. Coverage requires symptomatic disease (eg, pain, swelling, recurrent phlebitis, bleeding, refractory edema, venous ulceration, or stasis dermatitis), pre-treatment duplex ultrasound within 12 months showing vein diameter ≥3 mm and high-volume reflux (>500 ms or VFI>7 ml/s), CEAP class 2–6r (with a minimum 6‑week conservative trial for class 2–3), and is subject to limits and exclusions (one ablation per vein per 12 months, session and annual session caps per leg, and exclusions such as VenaSeal/Varithena for certain veins and other policy criteria).