Vein Ablation and Related Services Checklist

Published 11/19/2021

Veins are the blood vessels that carry deoxygenated blood from the tissues back to the heart.

Varicose veins are enlarged, swollen and twisting veins which often appear blue or dark purple when faulty valves in the veins allow blood to flow in the wrong direction, or to pool. This increases the pressure in the vein, often causing swelling, pain, itching and discoloration to the affected area. Endovenous ablation is a procedure to close off varicose veins. Endovenous means that the procedure is done inside the vein. Ablation heat is used to close off the vein.

Some patients may want varicose vein treatment for cosmetic reasons. Cosmetic surgery or expenses incurred in connection with such surgery is not covered by Medicare. Cosmetic surgery includes any surgical procedure directed at improving appearance, except when required for the prompt (i.e., as soon as medically feasible) repair of accidental injury, or for the improvement of the functioning of a malformed body member. If the patient has no symptoms, discomfort, functional impairments or activity limitations, treatment may not be appropriate.

General Documentation Requirements for Vein Ablation and Related Services

  • Doppler ultrasound
  • Documentation stating the presence or absence of DVT (deep vein thrombosis), aneurysm, and/or tortuosity (when applicable)
  • Documented Incompetence (reflux greater than 500msec) of the Valves of the Saphenous, Perforator or Deep venous systems consistent with the patient's symptoms and findings (when applicable)
  • Photographs if the clinical received is inconclusive
  • Patient's medical record must contain a history and physical examination supporting the diagnosis of symptomatic varicose veins (evaluation and complains), and the failure of an adequate (at least three months) trial of conservative management (before the initial procedure)
Vein Ablation and Related Services Checklist
Vein Ablation procedures are not covered if there is documentation of one or more of the following:
A.   Spider veins or superficial telangiectasia
B.   Inability to tolerate compressive bandages or stockings
C.   Severe distal arterial occlusive disease
D.   Evidence of obliteration of deep venous system or acute deep venous thrombosis
E.   Allergy to the sclerosant
F.    Pregnancy
G.   Klippel-Trenaunay Syndrome or other congenital venous abnormalities
H.   advanced generalized systemic disease that limits quality-of-life improvements expected following venous intervention
Documentation of Conservative Treatment
Documentation of a trial of conservative therapy such as exercise, periodic leg elevation, weight loss, compressive therapy (minimum 20–30 mmHg) and avoidance of prolonged immobility has failed.
Saphenous Veins Ablation
CEAP Class C2 of Saphenous Vein (Greater, Small, or Accessory), a venous reflux of greater than 500 milliseconds, and one or more of the following:
A.   Ulceration secondary to venous stasis   
B.   Significant pain and/or significant edema associated with saphenous reflux that interferes with activities of daily living
C.   Bleeding associated with ruptured superficial varicosity
D.   Recurrent episodes of superficial phlebitis
E.   Stasis dermatitis
F.    Refractory dependent edema
Symptomatic Varicose Tributaries Performed at the Same Time
A.   symptomatic varicose tributaries 2mm in diameter or greater
B.   If the requested procedure is following previous treatment to the Saphenous Vein(s) (Greater, Small, or Accessory), documentation is required to be submitted to verify previous Saphenous Vein(s) treatment
Perforator Vein: performed as a treatment of leg ulcers associated with chronic venous insufficiency and all of the following:
A.   Demonstrated perforator reflux
B.   The superficial saphenous veins (great, small or accessory saphenous and symptomatic varicose tributaries) have been previously eliminated
C.   Ulcers have not resolved following combined superficial vein treatment and compression therapy for at least 3 months
D.   Venous disease is not secondary to acute deep venous thromboembolism

Was this article helpful?