Varicose Vein Treatment — Reimbursement and Coding Guidance
Defines reimbursement, coding, documentation, and authorization expectations for varicose vein treatments billed to Priority Health; affects providers submitting claims for these services, including Medicare-related determinations.
New policy created and made effective 11/17/2025.
Coverage stance and requirements
Coverage stance and requirements
Covered when ALL of the following are met:
ALL of the following
- Service is furnished in an appropriate place of service aligned to the patient’s medical needs and condition (place of service must be appropriate for the procedure).
- Authorization is obtained when required by plan or based on the setting and patient needs.
Authorization may be required; obtain prior authorization when indicated.
- Documentation in the medical record fully supports the service, including procedure details, number of veins treated, access sites, and clinical indications for treatment.
CPT/HCPCS/revenue codes may be submitted only when the service was performed and documented to the highest level of specificity; failure to document may result in denial.
- Billing and coding comply with CPT, CMS, MDHHS and Priority Health billing policies and coding guidelines.
Priority Health may perform pre- or post-claim reviews for payment integrity; noncompliance can lead to claim denial or recoupment.
- For Medicare indications that do not meet NCD, local LCD, or specific medical policy criteria a Pre‑Service Organization Determination (PSOD) is required.
PSOD/authorization for Medicare cases that fall outside NCD/LCD or specific policy criteria.
- An authorization, when obtained, is not a guarantee of payment; payment remains subject to medical necessity, proper coding, and policy adherence.
Authorization does not supersede coding, billing, or reimbursement requirements.
Procedure codes and coding rules
| 37799 | Unlisted procedure, vessels (use when less than 10 stab phlebectomies are done) |
| 36470 | Sclerotherapy, single vein injected |
| 36474 | Sclerotherapy, subsequent vein(s) in same extremity |
| 36476 | ERFA second/subsequent vein in single extremity when separate access sites |
| 36475 | ERFA first vein on each extremity |
| 36482 | Endovenous chemical adhesive, includes adhesive reimbursement |
| 36483 | Subsequent veins treated with adhesive via separate access sites |
Authorization, documentation, and billing guidance
Pre-Service Organization Determination (PSOD) required for non‑NCD/LCD indications
For Medicare indications that do not meet the criteria of an NCD, local LCD, or specific medical policy, a Pre-Service Organization Determination (PSOD) must be completed before the service is provided. Authorization may also be required depending on the place of service and the patient's medical needs and condition.
Authorization is not a guarantee of payment
An authorization is not a guarantee of payment; payment is contingent on meeting medical necessity, adhering to Priority Health billing and coding requirements, and fully documenting the performed service. Failure to follow coding, billing, documentation, or policy guidelines may result in claim denial, recoupment, or rejection.
- Authorization does not supersede coding, billing, or reimbursement requirements.
- Services must be performed and fully documented to the highest level of specificity to support billed CPT/HCPCS/revenue codes.
- Priority Health may reject/deny claims or recover payment if program regulations, policy, or contractual requirements are not followed.
Terms and scope
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.