Varicose Veins of the Lower Extremity, Treatment of

LCD Information Document Information Source LCD ID N/A LCD ID L34082 Original ICD-9 LCD ID Not Applicable LCD Title Varicose Veins of the Lower Extremity, Treatment of Proposed LCD in Comment Period N/A Source Proposed LCD N/A Original Effective Date For services performed on or after 10/01/2015 Revision Effective Date For services performed on or after 10/09/2025 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date N/A Notice Period End Date N/A CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. 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Issue Issue Description This LCD outlines limited coverage for this service with specific details under Coverage Indications, Limitations and/or Medical Necessity. Issue - Explanation of Change Between Proposed LCD and Final LCD CMS National Coverage Policy Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See §1869(f)(1)(A)(i) of the Social Security Act.Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:Title XVIII of the Social Security Act (SSA):Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Coverage Indications, Limitations, and/or Medical Necessity weight reduction, a daily exercise plan, periodic leg elevation, and the use of graduated compression stockings. The conservative therapy must be documented in the medical record. The patient is considered symptomatic if any of the following signs and symptoms of significantly diseased vessels of the lower extremities are documented in the medical record: stasis ulcer of the lower leg, as above, significant pain and significant edema that interferes with activities of daily living, bleeding associated with the diseased vessels of the lower extremities, recurrent episodes of superficial phlebitis, stasis dermatitis, or refractory dependent edema. Additional indications and limitations are discussed according to type of treatment.In addition to the requirement for failure of a six-week trial of conservative treatment and the symptoms described above, coverage of endovenous ablation therapy is limited to patients with: a maximum vein diameter of 20 mm for laser ablation; absence of thrombosis or vein tortuosity, which would impair catheter advancement; and absence of significant peripheral artery disease. Interventional treatment of asymptomatic varicosities. Sclerotherapy for cosmetic purposes. Medicare cannot cover services which are not reasonable and necessary for the treatment of illness or injury or to improve the functioning of a malformed body member. The following interventional treatments are not considered medically reasonable or necessary and are denied as such: Interventional treatment of symptomatic varicosities without documentation of a failed six week trial of conservative therapy. Sclerotherapy for vessels larger than 4 mm in diameter. Reinjection following recanalization or failure of vein closure without recurrent signs or symptoms. Sclerotherapy of the saphenous vein at its junction with the deep system. Noncompressive sclerotherapy. Compressive sclerotherapy for large, extensive or truncal varicosities. Sclerotherapy, ligation and/or stripping of varicose veins, or endovenous ablation therapy are not covered for pregnant women, or patients with the inability to tolerate compressive bandages or stockings; severe distal arterial occlusive disease; obliteration of deep venous system; an allergy to the sclerosant; or a hypercoaguable state. Any interventional treatment that uses equipment or sclerosants not approved for such purposes by the FDA. Laser ablation of veins with a diameter greater than 20 mm. Endovenous ablation therapy in the presence of thrombosis or venous tortuosity which would impair catheter advancement. Summary of Evidence N/A Analysis of Evidence (Rationale for Determination) N/A