Varicose Veins

The injection of sclerosing solution into varicose leg veins for specific medical indications is eligible for payment for those patients who meet all of the following criteria:

• The patient should be symptomatic (e.g., the varicosities are resulting in pain, burning, etc.).
• There is no sapheno-femoral insufficiency or disease/occlusion of the deep venous system
• The veins are demonstrable (bulging) above the surface of the skin
• The varicosities are at least 5 millimeters in size
• Medical management (e.g., compression therapy) has failed
  

Multiple injections should be processed in accordance with the multiple surgery guidelines on Medical Policy Bulletin S-100, regardless of the number of injections given.

Ligation and stripping procedures (e.g., 37720, 37730) are also beneficial in the treatment of symptomatic varicose veins and, as such, are covered surgical services.

However, in some cases, limited sclerotherapy may be necessary during the routine surgical postoperative period to achieve a better and more complete surgical result. As such, sclerotherapy performed by the surgeon, his associate or, the assistant surgeon during the postoperative period following vein ligation and stripping procedures is part of the global surgical allowance.

Echosclerotherapy

Sclerotherapy is a treatment for varicose veins. In echosclerotherapy (S2202), duplex ultrasound is being utilized during sclerotherapy to guide the injections and enhance the precision of saphenous vein sclerotherapy. However, there are no proven indications that echosclerotherapy provides any advantage over and above conventional methods of treatment such as sclerotherapy or ligation and stripping. Echosclerotherapy is beyond the experimental/investigational stage but it is not generally accepted by the medical community as clinically useful as treatment for varicose veins. Therefore, it is not medically necessary. A participating, preferred, or network provider cannot bill the member for the denied service.

Telangiectases

The injection of sclerosing solution into telangiectases (intralesional injections) (codes 36468 and 36469), such as spider veins, hemangiomata and angiomata, is a noncovered service. Treatment of these superficial veins is most commonly provided for beautifying purposes, and therefore, is cosmetic in nature.

Any method of treatment for superficial telangiectases, including laser, is not covered.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Injections of sclerosing solution into superficial telangiectases are done primarily for cosmetic purposes and should be processed in line with the guidelines for cosmetic and reconstructive procedures (Medical Policy Bulletin S-28).

PRN References

10/1993, Sclerotherapy of Varicose Veins, coverage for
05/1994, Sclerotherapy, postoperative, reimbursement for
08/1998, Echosclerotherapy