Highmark Medical Policy Bulletin |
Section: | Surgery |
Number: | S-55 |
Topic: | Surgical Treatment of Varicose Veins |
Effective Date: | April 1, 2004 |
Issued Date: | April 5, 2004 |
Date Last Reviewed: |
Indications and Limitations of Coverage
When conservative treatments fail to provide relief from symptomatic varicosities, the following surgical options are eligible for reimbursement when reported for symptomatic varicose veins (454.0-454.8). When reported for non-symptomatic varicose veins (454.9) these surgical options are considered cosmetic. Participating, preferred, or network providers can bill the member for these denied services. Ligation and Stripping (procedure codes 37700-37785) Sclerotherapy (procedure codes 36470 and 36471)
Claims for multiple injections should be processed in accordance with the multiple surgery guidelines on Medical Policy Bulletin S-100. All secondary injections should be priced at 50% of the allowance. Description: Endovenous Radiofrequency Obliteration of the Greater Saphenous Vein (procedure code S2130) Description: Laser Obliteration of the Greater Saphenous Vein (procedure codes 76986, S2131)
Description: Non-Invasive Laser Treatment (procedure code 37799) In addition, this method of treatment for larger veins is considered investigational and, therefore, is not covered. Scientific evidence does not demonstrate the effectiveness of this treatment. A participating, preferred, or network provider can bill the member for the denied service. Ambulatory Phlebectomy (e.g., Stab Phlebectomy)(procedure codes 37765, 37766) Description: Transilluminated Powered Phlebectomy (procedure code 37785) Description: The following services are not eligible for reimbursement: Echosclerotherapy (procedure code S2202) Description: Treatment of Spider Veins
Procedure codes 17106-17108 should not be used to report the treatment of reticular veins and/or spider veins. Participating, preferred, or network providers can bill the member for services denied as cosmetic. See Medical Policy Bulletin S-28 for information regarding Cosmetic Surgery. Description Varicose veins, which usually occur in the lower extremities, are dilated superficial veins whose valves have become incompetent, permitting reversed blood flow when the extremities are in the dependent position. The vascular dilatation results from increased pressure within the veins, as often occurs if the individual stands for long periods of time. Genetics, pregnancy and obesity contribute to the development of varicose veins. Symptoms, which are not necessarily related to the size of the varicosity, include swelling, generalized leg aching, heaviness and restlessness, itching around the veins, leg cramps, leg muscles that tire easily and sores on the skin near the ankle. The veins may also appear stretched, bulging and discolored. Varicose veins should be treated conservatively with the use of elastic stockings to provide support during daily activities. Since prolonged standing exacerbates the condition, regular walking and elevating the feet as often as possible should be encouraged. |
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36468 | 36469 | 36470 | 36471 | 37700 | 37720 |
37730 | 37735 | 37760 | 37765 | 37766 | 37780 |
37785 | 76986 | S2130 | S2131 | S2202 |
Traditional (UCR/Fee Schedule) Guidelines
Injection of sclerosing solution into superficial telangiectases is done primarily for cosmetic purposes and should be processed in accordance with the guidelines for cosmetic and reconstructive procedures (Medical Policy Bulletin S-28) |
Comprehensive / Wraparound / PPO / Major Medical Guidelines
Any reference in this bulletin to non-billable services by a network provider may not be applicable to Major Medical.
Managed Care (HMO/POS) Guidelines
PRN References |
Closure of the Greater Saphenous Vein with Endoluminal Radiofrequency Thermal Heating of the Vein Wall in Combination with Ambulatory Phlebectomy: Preliminary 6-Month Follow-up, Dermatologic Surgery, Volume 26, Issue 5, May 2000 |
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