Varicose Vein Treatment
This document describes the guidelines used to assist with coverage decisions regarding treatment of varicose veins. These guidelines should be used only as a reference as actual eligible benefits are based on the specific plan provisions and/or exclusions.
Varicose vein treatment is eligible for benefit when it is medically necessary treatment of an illness as defined by the plan.
Not all varicose veins require medical treatment. Treatment recommended to correct significantly symptomatic varicosities or symptomatic complications of varicosities is normally considered a covered expense. Before proceeding with elective/non-urgent treatment, a preauthorization of coverage is recommended.
The plan does not provide coverage for treatment of varicose veins when the primary goal is to alter or improve appearance.
Common forms of varicose vein treatment include the following:
• Ligation and Excision
• Stab Phlebectomy
• Radiofrequency Ablation
• Endovenous Laser Ablation
The treating physician should submit documentation supporting the medical necessity of the recommended treatment. The following documentation is necessary for a complete review:
• Proposed treatment plan (to include AMA CPT codes)
• Current patient evaluation
• Prior consultations or treatment of the condition (or related symptoms)
• Documentation of all conservative management, including failure of a 3-6 month trial of compression therapy (compression/support hose)
• Doppler evaluation or duplex ultrasound of the varicosities
Following an internal review of the proposed treatment plan and submitted supporting documentation, if questions regarding medical necessity still exist, an outside medical review will be conducted.
General benefit information may be verified by faxing a request to 1-309-346-8265. The information will be returned by fax within twenty-four (24) working hours.
An insured may be liable for deductible, co-insurance, copayment amounts, usual and customary disallowed amounts, and/or non-covered services.