Varicose Veins Treatment Reimbursement and Prior-Authorization Policy
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Defines UHA reimbursement and prior-authorization requirements for surgical and procedural treatment of primary venous insufficiency manifested by varicose veins, including coverage criteria, limitations, coding guidance, and administrative documentation requirements for providers and members.
No material clinical or coverage changes in this revision.
Coverage criteria for varicose vein treatments
Coding and diagnostic criteria
| 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 |
| 36478 | Endovenous ablation therapy, percutaneous, laser; first vein treated |
| 36479 | Endovenous ablation therapy, percutaneous, laser; subsequent vein(s) treated |
| 37500 | Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) |
| 37700 | Ligation and division of long saphenous vein at saphenofemoral junction |
| 37718 | Ligation, division, and stripping |
| 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 |
Provider requirements and prior authorization
Prior authorization required — submit via UHA portal
Prior authorization is required. To request prior authorization, submit via UHA's online portal.
Required documentation to accompany prior authorization
Submit the following with the prior authorization request so UHA can review medical necessity: imaging studies and dated photographs, clinical notes describing symptoms and physical findings, and documentation of failure of conservative treatment. Duplex ultrasound studies must be dated, memorialized, and made available for review and the report must document reflux findings and the cut-off criterion for pathological reflux.
- Imaging studies and photographs (photographs must be dated and available for review)
- Clinical notes describing symptoms and physical findings
- Documentation of failure of conservative treatment
- Duplex ultrasound studies dated and memorialized; report must document presence/absence and extent of reflux, connection to symptomatic veins/ulcer, perforator and deep vein reflux, and specify the cut-off criterion for pathological reflux
- Ultrasound images must be labeled with anatomical structures and oriented per the policy requirements
Repeat sclerotherapy requires prior authorization with documentation of persistent functional complaints
Repeat sclerotherapy requires prior authorization and must include documentation that the patient has persistent functional complaints related to venous disease.
Definitions and disease classification
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