ModifiedUnitedHealthcarePolicy CS117NM.C

Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins (for New Mexico Only)

Defines medical necessity and coding guidance for surgical and endovenous treatments of venous insufficiency and varicose veins for UnitedHealthcare members in New Mexico.

Policy Summary

PayerUnitedHealthcare

PolicySurgical and Ablative Procedures for Venous Insufficiency and Varicose Veins (for New Mexico Only)

Policy CodePolicy CS117NM.C

Change TypeCoverage language revisedcoding updatesadded exclusions for perforator foam/CAC

Effective DateAug 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization and include duplex ultrasound reports documenting vein diameter and reflux (>=500 ms) when submitting procedures for endovenous ablation or related treatments.

SourceLink

POLICY UPDATE CHANGES

Changed coverage language to consider initial and subsequent treatment of GSV, SSV, and Accessory Veins with radiofrequency ablation, endovenous laser ablation, stripping with ligation and excision, endovenous foam sclerotherapy, and/or cyanoacrylate-based adhesive as reconstructive and medically necessary when all listed criteria are met.

Added language indicating ablation of incompetent perforator veins using endovenous foam sclerotherapy and/or cyanoacrylate-based adhesive is unproven and not medically necessary due to insufficient evidence of efficacy.

Replaced duplex ultrasound wording to allow interpretations reporting >= 500 ms reflux for GSV, SSV, or Accessory Veins (previously 'principal tributaries').

Added criterion that incompetent perforator veins treated must not be secondary to acute deep vein thrombosis.

Revised sclerotherapy coding and procedural references: removed CPT 37500 and 37799; clarified use of CPT 36465/36466 for targeted extremity truncal vein foam injections; narrowed coverage of 36470/36471 and marked 36468 (spider veins/telangiectasias) as cosmetic.

Removed language indicating that ligation, subfascial, endoscopic surgery for perforating veins is proven and medically necessary in certain circumstances.

Clarified that ablation of incompetent perforator veins using RFA or EVLA is reconstructive and medically necessary when criteria are met, while foam sclerotherapy and cyanoacrylate adhesive for perforators are unproven.

Added definitions for Superficial Vein, Telangiectasias/Spider Veins, and Tributary Vein; removed definitions for Cosmetic Procedures and Reconstructive Procedures.

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3 mmmin vein diameter (GSV/SSV/accessory)

500 msmin reflux duration (duplex)

3.5 mmmin perforator size for ablation

≤3covered sclerotherapy sessions/leg/yr

93.7%2‑yr NBCA occlusion rate

NMjurisdiction

Coverage Criteria and Medical Necessity

Incompetent Perforator Veins

Ablation of incompetent perforator veins using radiofrequency ablation or endovenous laser ablation is considered reconstructive and medically necessary when ALL of the following are met:

ALL of the following

Evidence of perforator venous insufficiency measured by a recent duplex ultrasound study performed in the standing or reverse Trendelenburg position.
Perforator vein size is 3.5 millimeters (mm) or greater.
Perforating vein reflux duration of 500 milliseconds (ms) or greater.
The perforating vein lies beneath a healed or active venous stasis ulcer (i.e., associated with CEAP class 4–6 changes affecting the area).
Not secondary to acute deep vein thrombosis.

Unproven Treatments

The following treatments for perforator veins and truncal veins are considered unproven and NOT MEDICALLY NECESSARY due to insufficient evidence of efficacy (these represent exclusions and investigational approaches):

ANY of the following

Endovenous foam sclerotherapy (ultrasound-guided foam sclerotherapy, including physician-compounded foam) when used to ablate incompetent perforator veins.
Cyanoacrylate-based adhesive (endovascular embolization using NBCA or proprietary cyanoacrylate systems) for treatment of incompetent perforator veins.
Endovenous mechanochemical ablation (MOCA) as a standalone treatment for venous reflux when evidence does not demonstrate non-inferiority to established thermal techniques for long-term occlusion and clinical outcomes.
Ligation of the GSV, SSV, or Accessory Veins at their junctions as a stand-alone procedure for treatment of venous reflux (excluding ligation performed to prevent propagation of clot in ascending superficial thrombophlebitis when anticoagulation is contraindicated or has failed).

Procedure Codes, Thresholds, and Coding Guidance

Procedure CPT CodesCPT

0744T	Insertion of bioprosthetic valve, open, femoral vein, including duplex ultrasound imaging guidance
36465	Injection of non-compounded foam sclerosant with ultrasound compression maneuvers; single incompetent extremity truncal vein
36466	Injection of non-compounded foam sclerosant with ultrasound compression maneuvers; multiple incompetent truncal veins, same leg
36468	Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk
36470	Injection of sclerosant; single incompetent vein (other than telangiectasia)
36471	Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg
36473	Endovenous ablation therapy, mechanochemical; first vein treated
36474	Endovenous ablation therapy, mechanochemical; subsequent vein(s) treated in single extremity
36475	Endovenous ablation therapy, radiofrequency; first vein treated
36476	Endovenous ablation therapy, radiofrequency; subsequent vein(s) treated in single extremity

1–10 of 22

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Covered CPT Codes (endovenous ablation group)CPTCovered

36478	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated
36479	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites
36482	Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (e.g., cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated

Covered CPT Codes (surgical group)CPTCovered

36483	Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive; subsequent vein(s) treated in a single extremity
37700	Ligation and division of long saphenous vein at saphenofemoral junction, or distal interruptions
37718	Ligation, division, and stripping, short saphenous vein
37722	Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below
37735	Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft
37765	Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions
37766	Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions
37780	Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure)
37785	Ligation, division, and/or excision of varicose vein cluster(s), 1 leg

Coding (not specified in excerpt)mixed

No specific CPT/HCPCS/ICD-10 or modifier codes are listed in this excerpt.

Procedural codes referenced elsewheremixed

not listed in this excerpt

Procedural CPT/HCPCS codes for MOCA, foam sclerotherapy, CAC, EVTA, and surgical valve implantation are referenced elsewhere in the full policy.

FDA device clearances/approvalsmixed

K071468	FDA 510(k) for ClariVein infusion catheter (informational)
P140018	FDA PMA for VenaSeal Closure System (informational)

Applicable CPT coding updates and notesCPT

36465	Sclerotherapy; includes guidance to refer to 36465/36466 per AMA when targeted vein is an extremity truncal vein and non‑compounded foam with ultrasound compression maneuvers is performed
36466	Sclerotherapy with ultrasound guidance; referenced for truncal vein foam injections per AMA guidance
36468	Sclerotherapy; for spider veins/telangiectasias — considered cosmetic
36470	Sclerotherapy (non‑truncal, non‑telangiectasia) — covered up to three sessions per leg within a year
36471	Sclerotherapy (non‑truncal, non‑telangiectasia) — covered up to three sessions per leg within a year
37500	Listed as removed from applicable codes in this revision
37799	Listed as removed from applicable codes in this revision

Duplex ultrasound reflux and diameter thresholds

Minimum truncal vein diameterGSV, SSV, or accessory vein ≥ 3.0 mm measured by duplex ultrasound (proximal thigh for GSV immediately below the saphenofemoral junction)

Duplex reflux duration (superficial trunks)>= 500 milliseconds (0.5 seconds) on duplex performed in standing or reverse Trendelenburg position

Interpretation allowanceDuplex reports phrasing 'moderate to severe reflux' are acceptable equivalents to numeric reflux thresholds

Varicose vein diameter threshold

Varicose vein diameter (CEAP C2)

Prior Authorization, Documentation, and Operational Guidance

Prior Authorization

Prior Authorization Required — Imaging, Clinical Evidence, and Coding Guidance

Prior authorization is required for procedures addressing superficial venous insufficiency. Requests must include recent duplex ultrasound reports (performed standing or in reverse Trendelenburg) documenting target vein reflux ≥ 500 ms and vein diameters, CEAP clinical class, and a summary of prior treatments. Authorization should list planned modalities (e.g., EVTA, RFA, EVLA, UGFS, CAC, MOCA) and include the device/agent name when applicable. Providers must obtain authorization per plan requirements and follow current CPT guidance when submitting codes.

Include duplex ultrasound report performed standing or reverse Trendelenburg
Document target vein reflux duration (≥ 500 ms) and vein diameter (GSV/SSV/accessory ≥ 3 mm; perforators ≥ 3.5 mm when applicable)
Provide CEAP clinical class and clinical indications (see symptom requirements)
List prior treatments (conservative care, prior ablations, stripping, sclerotherapy) and dates
Specify planned treatment modality and device/agent name (e.g., VenaSeal, Varithena, ClariVein)
Attach baseline VCSS or symptom score and planned follow-up duplex schedule

Clinical Background and Evidence Context

Chronic venous insufficiency and varicose veins arise from retrograde superficial venous flow and dilated superficial tributaries, producing symptoms that range from cosmetic concerns to significant morbidity including venous stasis dermatitis, superficial thrombophlebitis, bleeding, and ulceration. Duplex ultrasonography (B‑mode with Doppler) is the noninvasive standard to document reflux, measure vein diameters, and guide procedural planning.

The policy notes that ultrasound‑guided foam sclerotherapy (UGFS / PEM) provides symptomatic and appearance benefit in randomized trials but shows inferior long‑term anatomical success versus thermal ablation in meta‑analyses. Technology assessments and systematic reviews conclude PEM may be useful in selected patients, but uncertainties about comparative durability and optimal patient selection persist.

Cyanoacrylate embolization (also described as cyanoacrylate closure or CAC/NBCA) refers to endovascular delivery of tissue adhesive (eg, VenaSeal or other NBCA systems) to occlude truncal veins without tumescent anesthesia. Randomized trials and systematic reviews report high short‑term occlusion rates and favorable safety profiles versus thermal ablation, but limitations include loss to follow‑up, limited long‑term data in some series, and variability across studies.

Ultrasound‑guided foam sclerotherapy (UGFS) involves injection of sclerosant foam under ultrasound guidance. While randomized trials (including VANISH trials) and HTAs demonstrate symptomatic and cosmetic benefit, pooled long‑term anatomical success rates are lower compared with EVLA, RFA, and surgical stripping, and the literature recommends selective use based on anatomy and patient preference.

Definitions and Terminology

Duplex Ultrasonography — definition and role

Definition — Duplex UltrasonographyNoninvasive imaging combining B‑mode and Doppler to assess venous blood flow and direction; used to measure vein diameter and reflux

Role in careGold-standard diagnostic test to evaluate venous reflux and to plan procedures (preoperative roadmap)

Performance positionStudies and policy specify duplex performed in standing or reverse Trendelenburg position for reflux measurement

Varicose Veins — definition and CEAP reference

Definition — Varicose VeinsDilated subcutaneous tributaries ≥ 3 mm in diameter; corresponds to CEAP clinical class C2

MeasurementDiameter confirmed by duplex ultrasonography

Policy Update Log

2025-08-01coverage_revisionLatest

Revised coverage rationale: removed prior language that ligation/subfascial/endoscopic surgery for perforating veins was proven and updated stance on endovascular cyanoacrylate embolization for varicose veins; clarified coverage language for GSV/SSV/Accessory veins and added unproven designation for perforator foam/cyanoacrylate treatments.

2025-08-01criteria_update

Replaced duplex ultrasound wording to accept interpretations reporting ≥500 ms reflux for GSV, SSV, or Accessory Veins and clarified duplex positioning requirements.

Policy Summary

PayerUnitedHealthcare

PolicySurgical and Ablative Procedures for Venous Insufficiency and Varicose Veins (for New Mexico Only)

Policy CodePolicy CS117NM.C

Change TypeCoverage language revisedcoding updatesadded exclusions for perforator foam/CAC

Effective DateAug 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization and include duplex ultrasound reports documenting vein diameter and reflux (>=500 ms) when submitting procedures for endovenous ablation or related treatments.

SourceLink

On This Page

Porcine bioprosthetic venous valve implantation (e.g., VenoValve) outside of an FDA-approved indication or clinical trial enrollment.

> 3.0 millimeters (varicose veins defined as ≥ 3 mm in diameter; CEAP clinical class C2)

Anatomic contextDefines dilated subcutaneous tributaries consistent with CEAP C2

Measurement modalityDiameter confirmed by duplex ultrasonography

Duplex reflux duration

Primary duplex reflux threshold>= 0.5 seconds (500 milliseconds) for truncal veins used as eligibility metric in trials and criteria

Trial usageRCTs (eg, VeClose, Alhewy) used GSV reflux ≥ 0.5 seconds as an entry criterion

Study follow-up contextDuplex-assessed closure endpoints commonly reported at 3 months and beyond using this reflux definition

Vein diameter selection (treated in studies)

Reported treated vein maximum diameter in WAVES studyTreated saphenous and accessory veins reported up to 20 mm in diameter

Study typeProspective case series (WAVES) reporting closure of GSV, SSV, and accessory veins up to 20 mm

Clinical implicationLarge truncal/ accessory veins (up to 20 mm) have been treated in published series with cyanoacrylate closure

Duplex reflux duration (policy reiteration)

Reflux duration threshold reiterated> 500 milliseconds (ms) defined as pathological reflux for superficial truncal and perforator veins

Guideline supportSVS/AVF/AVLS/SIR statement defines reflux >500 ms as abnormal in superficial truncal veins

Policy restatementPolicy adopts ≥ 500 ms duplex reflux criterion for eligibility and documentation

Pathologic perforator diameter

Pathologic perforator diameter>= 3.5 mm by duplex ultrasound (with outward flow duration ≥ 500 ms to be considered pathologic)

Combined perforator criteriaPerforator considered pathologic when diameter ≥ 3.5 mm and reflux duration ≥ 500 ms

Clinical applicationPerforator size and reflux criteria are used to guide ablation decisions, particularly in ulcer-related disease

UGFS saphenous trunk diameter consideration

UGFS trunk diameter considerationUGFS may be considered for saphenous trunks with diameter < 6 mm

Guideline basisESVS and NICE guidance note UGFS suitability for trunks <6 mm or when endovenous ablation is unsuitable

Evidence caveatUGFS shows lower long-term anatomical success versus EVLA/RFA in meta-analyses and may be less durable

Duplex reflux duration (policy restatement)

Policy duplex reflux threshold (restated)>= 500 milliseconds (ms) on duplex performed in standing or reverse Trendelenburg position for targeted GSV, SSV, Accessory, or perforator veins

Perforator-specific notePerforator veins must also meet size criteria (≥3.5 mm) and not be secondary to acute DVT when treated

Documentation expectationDuplex study and clinical CEAP class should be documented to support eligibility using these thresholds

Documentation Required

Clinical Evidence and Follow-up Documentation Needed for Authorization

Authorization submissions must demonstrate symptomatic venous reflux with clinical documentation of symptoms (e.g., pain causing functional impairment, venous stasis dermatitis, ulceration, bleeding, or superficial thrombophlebitis). For treatment of perforator veins, include evidence the perforator lies beneath a healed or active venous stasis ulcer and is not secondary to acute DVT. Planned follow-up assessment must be documented (e.g., duplex closure assessment timepoints).

Clinical symptom documentation (VCSS or symptom scores)
For perforator treatment: duplex showing perforator reflux ≥ 500 ms and diameter ≥ 3.5 mm, ulcer location, and absence of acute DVT
Planned post-procedure duplex timing (example: day 3, 1 month, 3 months, then periodic follow-up)

Denial Risk

Denial Risk and Coding / Coverage Exclusions

Some procedures and coding scenarios are unproven or excluded and may be denied. Stand‑alone ligation of truncal or accessory veins, and ablation of perforator veins using foam sclerotherapy or cyanoacrylate adhesive, are identified as unproven/not medically necessary for many indications and are at high risk for denial without robust supporting evidence. Treatments for spider veins/telangiectasias and endovenous ablation of reticular/telangiectatic veins are excluded as cosmetic. Use current CPT guidance for primary vs add-on code reporting (e.g., only one initial ablation code per extremity and one add‑on code per extremity for subsequent veins).

Unproven/not medically necessary: foam or cyanoacrylate for perforator veins (likely denial)
Unproven/not medically necessary: stand‑alone ligation of GSV/SSV/accessory veins (likely denial)
Excluded (cosmetic): treatments for spider veins/telangiectasias and endovenous ablation of reticular/telangiectatic veins
Coding: follow AMA guidance for initial and add‑on ablation codes per extremity

Step Therapy

Preferred First-Line Treatments and Step‑Therapy Guidance

Preferred first-line therapies are guideline-aligned: endovenous thermal ablation (EVTA — EVLA or RFA) is the guideline-recommended first choice for symptomatic GSV/SSV incompetence. UGFS may be appropriate for small trunks (< 6 mm) or anatomical situations precluding endovenous cannulation. No formal step therapy sequence is mandated by this policy, but sequencing should consider comparative evidence and less‑effective or less‑invasive modalities when clinically appropriate.

EVLA or RFA preferred first-line for GSV/SSV incompetence
UGFS may be considered for small-diameter trunks or tortuous anatomy (< 6 mm)
Policy does not require a specific step-therapy sequence; clinical judgment and evidence should guide sequencing

Note

Device‑Specific Documentation, Credentialing, and Clinical Governance

Operational and governance expectations: procedures using devices or novel agents must document the device/agent name, indication, and demonstrate adherence to device instructions for use and local clinical governance. Clinicians performing procedures should have appropriate training and experience in venous ultrasound and the selected technique. UnitedHealthcare may apply third‑party decision tools (e.g., InterQual) to evaluate ambulatory phlebectomy and other procedures.

Include device/agent name and indication in authorization and procedural documentation
Confirm clinician training/experience in venous ultrasound and the procedural technique
Adhere to device IFU and institutional clinical governance; be prepared for audit or outcomes reporting

Clinical classificationCEAP 'C' staging (C2–C6) used to describe severity in policy and trials

Moderate to Severe Pain — VCSS-based definition

Moderate to severe pain (VCSS)Per VCSS: moderate pain = daily pain interfering with activities; severe pain = daily pain limiting most regular daily activities

Use in eligibilityModerate to severe pain causing functional or physical impairment qualifies as a covered indication when other criteria met

Assessment toolVenous Clinical Severity Score (VCSS) referenced for pain severity definitions

CEAP C2 — varicose vein diameter threshold reference

CEAP C2 referenceCEAP C2 corresponds to varicose veins defined as diameter > 3 mm (used throughout policy)

Clinical relevanceCEAP staging is used to contextualize treatment appropriateness and trial populations (commonly C2–C5)

Measurement modalityDiameter assessment via duplex ultrasonography

Endovenous adhesive embolization — definition (cyanoacrylate closure)

Endovenous adhesive embolization (CAE/CAC) definitionTranscatheter delivery of cyanoacrylate adhesive to close superficial truncal veins (non‑thermal, non‑sclerosant) often without tumescent anesthesia

Examples/devicesVenaSeal cited as a cyanoacrylate closure system evaluated in pivotal trials (VeClose)

Clinical contextStudied as alternative to RFA/EVLA with comparable short-term closure in RCTs and systematic reviews

Mechanochemical ablation (ClariVein) — definition and mechanism

Mechanochemical ablation (MOCA) definitionCatheter-based mechanical endothelial disruption with simultaneous infusion of sclerosant (eg, ClariVein) to induce vein sclerosis and occlusion

MechanismRotating dispersion wire creates mechanical damage while liquid sclerosant is infused to achieve occlusion

Evidence noteSystematic reviews/meta-analyses report good short-term anatomic success (pooled ~92%) but limited RCT long-term data versus EVTA

Cyanoacrylate embolization — definition and context

Cyanoacrylate embolization (CAE/CAC/NBCA) definitionEndovascular occlusion of truncal veins using cyanoacrylate glue (eg, NBCA/VenaSeal) to achieve vein closure without tumescent anesthesia

Evidence contextEvaluated in RCTs (VeClose, Alhewy) and systematic reviews showing high short-term occlusion rates and favorable procedural profiles

LimitationsLonger-term and broader comparative data have limitations; some studies excluded prior GSV treatment and certain comorbidities

Ultrasound-guided foam sclerotherapy (UGFS) — definition and outcome context

Ultrasound-guided foam sclerotherapy (UGFS) definitionInjection of sclerosant foam under ultrasound guidance to damage the endothelium and occlude veins

Outcome contextUGFS shows symptomatic and appearance benefits in RCTs (VANISH trials) but lower long-term anatomical success versus EVLA/RFA in meta-analyses

Product examplePolidocanol endovenous microfoam (PEM, Varithena) is a proprietary foam studied in randomized trials

CAC (cyanoacrylate closure) — definition and device examples (VenaSeal)

CAC (cyanoacrylate closure) definition and device exampleEndovenous closure of incompetent truncal veins using cyanoacrylate adhesive (eg, VenaSeal Closure System, PMA P140018)

Regulatory noteVenaSeal received FDA PMA (P140018) and has been the subject of pivotal RCTs (VeClose)

Clinical evidenceVeClose and other studies report duplex-assessed closure and patient-reported outcomes at multiple follow-up intervals

PEM (polidocanol endovenous microfoam, Varithena) — definition and use

PEM (polidocanol endovenous microfoam) definitionPharmaceutical-grade polidocanol 1% microfoam (Varithena) used for endovenous foam sclerotherapy to treat varicose veins and truncal vein incompetence

Clinical evidenceVANISH and related randomized trials demonstrate symptom and appearance benefit versus placebo with acceptable safety profiles

Comparative findingsNetwork meta-analyses show PEM comparable to EVTA for closure in some analyses but longer-term comparative data remain limited

MOCA — definition and examples

MOCA (mechanochemical ablation) definition and examplesNon‑thermal technique (eg, ClariVein) combining mechanical endothelial disruption with simultaneous liquid sclerosant infusion to occlude saphenous veins

Device exampleClariVein is the commonly cited MOCA system in published studies and reviews

Evidence summarySystematic reviews report high short-term anatomical success but limited high-quality long-term RCT comparisons versus EVTA

CAC (cyanoacrylate closure / glue) — off-label perforator uses and definition

CAC (cyanoacrylate closure / glue) off-label usesCyanoacrylate adhesive closure is used off‑label in some perforator vein applications though evidence for perforator CAE is limited

Evidence cautionPolicy and reviews note limited quality evidence for cyanoacrylate use in perforator veins and call for RCTs

GuidanceNICE and other bodies recommend governance, training, and audit when using CAE techniques

VenoValve — investigational surgically implanted venous valve description

VenoValve descriptionSurgically implanted porcine bioprosthetic venous valve intended to restore valvular function for chronic venous insufficiency

Development statusEvidence limited to small first‑in‑human and early series (≤11 patients); device is investigational and not FDA‑approved

Reported outcomesEarly reports show improvements in VCSS, reflux time, pain, and QOL but require larger RCTs and longer follow-up

Reflux (duplex) — definition and numeric threshold

Reflux (duplex) numeric definitionReflux defined as a minimum reversed flow duration > 500 milliseconds (ms) in superficial truncal and perforator veins

Guideline endorsementSVS/AVF/AVLS/SIR guidance endorses duplex as diagnostic test of choice and specifies >500 ms reflux threshold

Clinical useUsed as an objective eligibility metric for ablation and as an outcome measure in trials

Pathologic perforating vein — definition and numeric thresholds

Pathologic perforating vein definitionPerforator with outward flow duration ≥ 500 ms and diameter ≥ 3.5 mm on duplex ultrasound (in patients with varicose veins, CEAP C2)

Source guidanceDefined in SVS/AVF/AVLS/SIR statements and reflected in policy perforator criteria

Implication for treatmentPerforators meeting these numeric thresholds and lying beneath an ulcer or symptomatic area may be considered for ablation (RFA/EVLA)

Superficial Vein — newly added definition referenced in policy

Superficial Vein — policy definitionVeins located above the muscular fascia as newly added definition in the policy

PurposeAdded to clarify anatomic descriptors used in coverage criteria and exclusions

ReferenceDefinition added in the policy 'Definitions' section (see policy updates)

Telangiectasias/Spider Veins — newly added definition referenced in policy

Telangiectasias/Spider Veins — policy definitionDilated small superficial veins measuring less than 1 mm in diameter (telangiectasias/spider veins), newly added wording in policy

Coverage implicationTreatment of telangiectasias/spider veins (CPT 36468) is considered cosmetic and excluded

Measurement modalityDistinguished from varicose veins (≥3 mm) by size on duplex or clinical exam

Tributary Vein — newly added definition referenced in policy

Tributary Vein — policy definitionSmall superficial veins in the legs running close to the skin within the superficial subcutaneous plane (tributary veins), newly added in policy

Clinical distinctionUsed to differentiate tributary/reticular veins from truncal saphenous trunks and telangiectasias

Coverage relevanceDefinitions clarify which veins are eligible for ablation versus those considered cosmetic

Added requirement that treated incompetent perforator veins must not be secondary to acute deep vein thrombosis and standardized perforator reflux threshold to ≥500 ms.

2025-08-01coding_update

Updated coding: removed CPT 37500 and 37799; clarified use of CPT 36465/36466 guidance for truncal foam injections and narrowed coverage language for CPT 36470/36471 and cosmetic designation for 36468.