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Vein Ablation

OPD Procedure: Vein Ablation

Vein ablation procedures consist of sclerotherapy (non-compressive or compressive), vein ligation with/without stripping, endovenous radiofrequency and endovenous laser ablation. Vein ablation procedures performed for cosmetic reasons are not covered by Medicare.

Medical Necessity

Services are considered reasonable and medically necessary in patients who meet one or more of the following:

  • H&P support findings of a diagnosis of symptomatic varicose veins
  • Failure of at least 2 conservative treatments tried for at least 6 weeks which may include:
    • Exercise plan
    • Pharmacological
    • Compression stockings
    • Leg elevation
    • Weight reduction
  • Exclusion of other causes of edema, ulceration and pain in limbs
  • Appropriate tests to confirm the presence of incompetent valves
  • Only 1 sclerotherapy service per treatment session should be reported for either leg regardless of how many veins are treated
  • Patient symptomatic due to diseased vessels of the lower extremities which may include the following:
    • Significant pain and edema that interfere with ADLs
    • Bleeding associated with diseased vessels
    • Itching, stasis dermatitis
    • Burning

General Documentation Requirements

  • Clinical evaluations related to the patient’s pain
  • Current H&P, office visit notes/progress notes
  • Doppler ultrasound studies showing venous insufficiency
  • Clinical etiological anatomical pathophysiology (CEAP) class C2 or greater of the saphenous vein, venous reflux > 500 milliseconds
  • Documentation related to previous conservative treatments tried
  • Documentation on how their pain affects their ADLs

Prior Auth Request Form

Prior Authorization OPD: Vein AblationPDF

Coverage Criteria and Resources


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