CurrentSecurity Health Plan of Wisconsin, Inc.Policy N/A

Varicose Vein Treatments

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This policy governs coverage, medical-necessity review, limitations, exclusions, and site-of-service requirements for varicose vein treatments across Security Health Plan commercial, Medicaid, Family Health Center, Medicare Advantage, and third-party administrator products. Prior authorization is generally not required, but applicable clinical criteria must be met when the claim is submitted.

Policy Summary

PayerSecurity Health Plan of Wisconsin, Inc.

PolicyVaricose Vein Treatments

Policy CodePolicy N/A

Change TypeAdministrative and product applicability updateno material clinical or coverage changes

Effective DateJanuary 1, 2026

Next Review DateN/A

Key ActionEnsure the member meets applicable clinical criteria when the claim is submitted.

SourceLink

POLICY UPDATE CHANGES

Align, Align DSNP, and Great Plains Medicare Advantage health plans were added to the policy effective January 1, 2026.

ForwardHealth wording was updated regarding reduced reimbursement for services provided in facility settings, and the CMS link was updated.

Not requiredPrior authorization

3/leg/yearCommercial sclerotherapy limit

5Experimental treatment categories

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CurrentSecurity Health Plan of Wisconsin, Inc.Policy N/A

Varicose Vein Treatments

Customize your policy alerts

Sign up for all security_health_plan_of_wisconsin_inc policy alerts

Know when security_health_plan_of_wisconsin_inc releases new policies or updates existing guidance.

Monitor payer policy activity

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Policy Summary

PayerSecurity Health Plan of Wisconsin, Inc.

PolicyVaricose Vein Treatments

Policy CodePolicy N/A

Change TypeAdministrative and product applicability updateno material clinical or coverage changes

Effective DateJanuary 1, 2026

Next Review DateN/A

Key ActionEnsure the member meets applicable clinical criteria when the claim is submitted.

SourceLink

POLICY UPDATE CHANGES

Align, Align DSNP, and Great Plains Medicare Advantage health plans were added to the policy effective January 1, 2026.

ForwardHealth wording was updated regarding reduced reimbursement for services provided in facility settings, and the CMS link was updated.

Not requiredPrior authorization

3/leg/yearCommercial sclerotherapy limit

5Experimental treatment categories

Medical Necessity and Product-Specific Coverage

General clinical criteria

Coverage is subject to applicable product-specific clinical criteria.

General medical-necessity requirement: The member must meet the applicable clinical criteria when the claim is submitted.

InterQual criteria are used for predeterminations where stated.

BadgerCare Plus and Medicaid SSI

BadgerCare Plus follows the Commercial policy when no separate guidelines are available.

BadgerCare Plus criteria: BadgerCare Plus members are evaluated under the Commercial policy; the plan will not be more restrictive than fee-for-service Medicaid under the BadgerCare Plus HMO contract.

ForwardHealth fee schedules and program requirements also apply.

Medicare Advantage treatment guidance

For Medicare Advantage, accepted treatments for eliminating saphenous reflux include the following.

Accepted saphenous reflux treatments: Radiofrequency ablation, laser ablation, polidocanol microfoam, cyanoacrylate embolization ablation, or mechanochemical ablation may be accepted under Medicare guidelines for saphenous reflux.

The policy identifies great saphenous vein, anterior accessory great saphenous vein, and small saphenous vein reflux, including saphenofemoral or saphenopopliteal reflux.

Family Health Center site-of-service criteria

For Family Health Center members, coverage depends on meeting criteria and the place of service.

FHC coverage: The service must meet the applicable Commercial clinical criteria and be performed in an office setting for coverage.

No facility or professional fee coverage applies when performed in an ambulatory surgery center, outpatient surgery, observation, or inpatient setting.

Sclerotherapy, ligation and/or stripping of varicose veins, and endovenous ablation therapy are not covered for pregnant persons or patients with acute deep vein thrombosis (DVT).

Photothermal sclerosis, including treatment using an intense pulsed light source, for small varicose veins and spider veins is considered cosmetic and not medically necessary.

Sclerotherapy and laser or pulsed-light therapy for small cutaneous spider veins are considered cosmetic, except when performed with more extensive varicose vein surgery or when associated hemorrhage is present.

Treatment of spider veins is excluded as cosmetic, subject to the qualifying circumstances stated for treatment performed with more extensive varicose vein surgery or when associated hemorrhage is present.

Services that do not meet the applicable clinical criteria are denied as not medically necessary.

The policy considers listed cosmetic treatments not medically necessary, including treatment of small varicose veins and spider veins, except when small cutaneous spider-vein treatment is performed with more extensive varicose vein surgery or when associated hemorrhage is present.

Authorization, Billing, and Denial Risks

Prior Authorization

Commercial Authorization

No prior authorization is required for Commercial members. The member must meet applicable clinical criteria when the claim is submitted; the Health Plan may use InterQual criteria to determine medical necessity for predeterminations.

Prior Authorization

Medicaid Authorization

No prior authorization is required for BadgerCare Plus and Medicaid members. Clinical criteria must be met when the claim is submitted, and InterQual criteria may be used to determine medical necessity for predeterminations. BadgerCare Plus follows the Commercial policy and is not more restrictive than fee-for-service Medicaid.

Check the ForwardHealth interactive fee schedule for payable services, provider types, specialties, and places of service.
ForwardHealth may reduce reimbursement for professional services typically provided in an office when performed in a hospital (POS 21 or 22) or ambulatory surgery center (POS 24).

Policy Scope

This policy addresses interventions used to treat varicose veins and saphenous venous reflux, including sclerotherapy, radiofrequency ablation, laser ablation, and other endovenous techniques. Coverage varies by product; some treatments are considered cosmetic or experimental for Commercial members, while Medicare Advantage follows applicable Medicare treatment guidance.