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ICD-10-CM I83.90, Asymptomatic varicose veins of unspecified lower extremity | No Prior Auth

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`I83.90`, Asymptomatic varicose veins of unspecified lower extremity

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Key Coverage Criteria

Endoluminal radiofrequency ablationorendoluminal laser ablation:
The following modalities are consideredmedically necessarywhen the criteria below (I, II,andIII) have been met:
Ablative Modalities:Endoluminal radiofrequency;orEndoluminal laser;and
Endoluminal radiofrequency;or
Endoluminal laser;and
The veins to be treated include one or more of the following:Anterior accessory great saphenous vein (AAGSV) also known as anterior saphenous vein (ASV);orGreat saphenous vein (GSV);orSmall saphenous veins (SSV)and

1 Active Policy

ANTHEM-CG-SURG-119, Treatment of Varicose Veins (Lower Extremities)

Related Codes

36466(1 policies)36468(1 policies)36470(1 policies)36471(1 policies)36473(1 policies)36474(1 policies)36475(1 policies)36465(1 policies)

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