CurrentUnitedHealthcarePolicy MMP099.10

Varicose Veins Treatment and Other Vein Embolization Procedures

Medicare Advantage policy describing coverage framework, applicable CPT codes, and references to LCDs/LCAs and InterQual criteria for stab phlebectomy (<10 incisions) and endomechanical ablation (ClariVein/MOCA) of incompetent extremity veins. Applicable to UnitedHealthcare Medicare Advantage plans; local LCD/LCA compliance required where applicable.

Policy Summary

PayerUnitedHealthcare

PolicyVaricose Veins Treatment and Other Vein Embolization Procedures

Policy CodePolicy MMP099.10

Change TypeRoutine review; no change to coverage guidelines

Effective DateJul 1, 2025

Next Review Date

Key ActionProviders must retain or have access to appropriate documentation to support coverage and follow applicable LCD/LCA or InterQual/UnitedHealthcare commercial policy guidance where required.

POLICY UPDATE CHANGES

Routine review; no change to coverage guidelines.

3Primary procedure codes listed

MultipleReferenced LCD/LCA documents

0Material clinical changes in this revision

Coverage Summary

This Medicare Advantage policy addresses coverage framework for treatment of varicose veins and endomechanical vein ablation. It applies to UnitedHealthcare Medicare Advantage plans and lists applicable CPT codes and referenced contractor guidance. The policy is effective 07/01/2025 with last review on 06/11/2025.

Policy metadata

Policy numberMMP099.10

Effective date2025-07-01

Last review2025-06-11

Scope summaryMedicare Advantage policy describing coverage framework, applicable CPT codes, and references to LCDs/LCAs and InterQual criteria for stab phlebectomy (<10 incisions) and endomechanical ablation (ClariVein/MOCA) of incompetent extremity veins; applicable to UnitedHealthcare Medicare Advantage plans; local LCD/LCA compliance required where applicable.

Medical-Necessity Criteria

General Coverage Framework

Policy references and coverage governance (no specific patient-level clinical inclusion/exclusion criteria provided in this document):

ALL of the following

Compliance with applicable Local Coverage Determinations (LCDs) and Local Coverage Articles (LCAs) is required where they exist.
For states/territories with no LCDs/LCAs, refer to InterQual® CP: Procedures, Phlebectomy, Lower Extremity Superficial Tributary Varicose Vein or UnitedHealthcare Commercial Medical Policy titled Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins, as specified.
Benefit coverage is determined by the member-specific benefit plan document and applicable law; inclusion of codes does not imply coverage.

Stab Phlebectomy Less Than 10 Incisions

Coverage direction:

ALL of the following

Medicare does not have a National Coverage Determination (NCD) for stab phlebectomy less than 10 incisions.
When LCDs/LCAs exist for stab phlebectomy less than 10 incisions, compliance with those policies is required.
If no LCD/LCA exists for the state/territory, use InterQual® CP: Procedures, Phlebectomy, Lower Extremity Superficial Tributary Varicose Vein for coverage guidance.

Endomechanical Ablation of Incompetent Extremity Veins (MOCA/ClariVein)

Coverage direction:

ALL of the following

Medicare does not have a National Coverage Determination (NCD) for endomechanical ablation of incompetent extremity veins.
When LCDs/LCAs exist for endomechanical ablation, compliance with those policies is required.
For states/territories with no LCDs/LCAs, refer to the UnitedHealthcare Commercial Medical Policy titled Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins for coverage guidelines.

Coding

Endomechanical ablation CPT codesCPT

36473	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated.
36474	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure).
37799	Unlisted procedure, vascular surgery [Refer to the InterQual® CP: Procedures, Phlebectomy, Lower Extremity Superficial Tributary Varicose Vein]

Referenced CMS LCDs/LCAs and related documentsmixed

L38720	Treatment of Chronic Venous Insufficiency of the Lower Extremities
A58250	Billing and Coding: Treatment of Chronic Venous Insufficiency of the Lower Extremities
L33575	Varicose Veins of the Lower Extremity, Treatment of
A52870	Billing and Coding: Treatment of Varicose Veins of the Lower Extremity
L34209	Treatment of Varicose Veins of the Lower Extremities
A53084	Billing and Coding: Sclerosing of Varicose Veins
A57706	Billing and Coding: Treatment of Varicose Veins of the Lower Extremities
L34010	Treatment of Varicose Veins of the Lower Extremities
A53079	Billing and Coding: Sclerosing of Varicose Veins
A57707	Billing and Coding: Treatment of Varicose Veins of the Lower Extremities

1–10 of 16

1/2

Provider Actions

Documentation Required

Retain documentation to support coverage decisions

Providers must retain or have access to appropriate documentation when requested to support coverage; follow member-specific benefit plan documentation and applicable LCD/LCA requirements.

Prior Authorization

Follow delegate prior authorization requirements where applicable

For members where a delegate manages utilization management and prior authorization, the delegate's requirements must be followed.

Documentation Required

Use InterQual or UnitedHealthcare commercial policy where LCD/LCA absent

When no LCD/LCA exists for the state/territory, use InterQual CP or the referenced UnitedHealthcare commercial policy as the coverage guidance; document adherence.

Background

This Medicare Advantage policy addresses treatment of varicose veins including stab phlebectomy with fewer than 10 incisions and endomechanical ablation (MOCA/ClariVein®) of incompetent extremity veins. Applicable CPT procedure codes for endomechanical ablation (for example 36473, 36474) and an unlisted vascular surgery code (37799) are referenced for coding guidance.

The policy requires compliance with applicable Medicare contractor LCDs/LCAs where they exist. For states or territories without LCDs/LCAs, the policy directs use of InterQual® CP: Procedures, Phlebectomy, Lower Extremity Superficial Tributary Varicose Vein for stab phlebectomy, and the UnitedHealthcare Commercial Medical Policy titled Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins for endomechanical ablation, as coverage guidance.

Endomechanical ablation — also known as ClariVein®, mechanochemical ablation (MOCA), mechanico-chemical endovenous ablation (MCEA), and mechanically enhanced endovenous chemical ablation (MEECA) — refers to mechanochemical methods for endovenous ablation of incompetent extremity veins.

Name	Type
Endomechanical Ablation of Incompetent Extremity Veins	LCD
Stab Phlebectomy Less Than 10 Incisions	LCD

Policy Summary

PayerUnitedHealthcare

PolicyVaricose Veins Treatment and Other Vein Embolization Procedures

Policy CodePolicy MMP099.10

Change TypeRoutine review; no change to coverage guidelines

Effective DateJul 1, 2025

Next Review Date

Key ActionProviders must retain or have access to appropriate documentation to support coverage and follow applicable LCD/LCA or InterQual/UnitedHealthcare commercial policy guidance where required.

On This Page

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Varicose Veins Treatment and Other Vein Embolization Procedures

Coverage Summary

Medical-Necessity Criteria

Coding

Provider Actions

Background

Medicare Determinations

Revision History