Highmark Medical Policy Bulletin |
Section: | Surgery |
Number: | S-55 |
Topic: | Surgical Treatment of Varicose Veins |
Effective Date: | April 3, 2006 |
Issued Date: | April 3, 2006 |
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 Incompetent Veins (procedure codes 36475, 36476) Description: The catheter insertion is part of the overall procedure and should not be billed separately. If billed separately (e.g., 36010, 36011), the catheter insertion should be denied as not covered. A participating, preferred, or network provider cannot bill the member for the denied service. Laser Obliteration of Incompetent Veins (procedure codes 36478, 36479)
Description: Ambulatory Phlebectomy (e.g., Stab Phlebectomy - procedure codes 37765, 37766, 37799) Description: When performing fewer than ten (10) incisions, report 37799. Transilluminated Powered Phlebectomy (procedure code 37785) Description: The following services are not eligible for reimbursement: Echosclerotherapy (procedure code S2202) 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. Subfascial Endoscopic Perforator Surgery (SEPS - procedure code 37500) 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 | 36475 | 36476 |
36478 | 36479 | 37500 | 37700 | 37718 | 37722 |
37735 | 37760 | 37765 | 37766 | 37780 | 37785 |
37799 | 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 10/1993, Sclerotherapy of Varicose Veins, coverage for |
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 Treatment of Primary Venous Insufficiency by Endovenous Saphenous Vein Obliteration, Vascular Surgery, Volume 34, No. 3, May/June 2000 Endovenous Techniques for Elimination of Saphenous Reflux: A Valuable Treatment Modality, Dermatologic Surgery, Volume 27, No. 10, October 2001 Closure of the Greater Saphenous Vein with Endoluminal Radiofrequency Thermal Heating of the Vein Wall in Combination with Ambulatory Phlebectomy: 50 Patients with More than 6-Month Follow-up, Dermatologic Surgery, Volume 28, No. 1, January 2002 Controlled Radiofrequency Endovenous Occlusion Using a Unique Radiofrequency Catheter Under Duplex Guidance to Eliminate Saphenous Varicose Vein Reflux: A 2-Year Follow-up, Dermatologic Surgery, Volume 28, No. 1, January 2002 Endovenous Laser Treatment of the Incompetent Greater Saphenous Vein, Journal of Vascular Interventional Radiology, Volume 12, No. 10, October 2001 Endovenous Laser: A New Minimally Invasive Method of Treatment for Varicose Veins – Preliminary Observations Using an 810 nm Diode Laser, Dermatologic Surgery, Volume 27, 2001 Powered Phlebectomy (TriVex) in Treatment of Varicose Veins, Annals of Vascular Surgery, 2002 MPRM 7.01.90 |