Highmark Medical Policy Bulletin |
Section: | Surgery |
Number: | S-55 |
Topic: | Injection of Sclerosing Solution into Varicose Veins and Telangiectasis |
Effective Date: | April 8, 2002 |
Issued Date: | April 8, 2002 |
Date Last Reviewed: |
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:
This procedure should be reported under codes 36470 and 36471, as appropriate. Sclerotherapy treatment for reasons other than those listed above remains a cosmetic procedure, and therefore, is not covered. 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. |
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36468 | 36469 | 36470 | 36471 | S2202 |
Traditional (UCR/Fee Schedule) Guidelines
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). |
Comprehensive/Wraparound/PPO Guidelines
Managed Care (HMO/POS) Guidelines
PRN References |
[Version 002 of S-55] |
[Version 001 of S-55] |
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