Medicare local coverage determination (LCD) for treatment of varicose veins is specific for each geographic region. The summary below emphasizes the main elements for Southern California (LCD for Southern California).
For more accurate and detailed information please access the Medicare Coverage Database (MAC) to view LCDs for your region. Our intention is to highlight some points only that you should pay attention to when reading the article.
1. 6-8 weeks conservative therapy (i.e. compression stockings, weight reduction, leg elevation, exercise) is necessary prior to treatment of varicose veins. It should be included in your documentation.
2. Sclerotherapy is considered medically necessary for the treatment of small and medium veins (less then 4mm). Sclerotherapy should not be used for treatment of veins with diameter of more than 5mm and for treatment of saphenous vein at its junction with the deep system.
3. Medicare covers stab microphlebectomy on the same leg performed the same day with endovenous laser or RF ablation if criteria for necessary services are met and documented properly.
4. Sclerotherapy, stripping, ligation, and endovenous ablation are not covered for pregnant women, patients on anticoagulation therapy, with severe occlusive arterial disease, obliteration of deep venous system, allergies, or in hypercoagulable state.
5. No more than 3 sclerotherapy sessions per leg are covered.
6. Post procedural ultrasound is covered when performed within 1 week (preferably within 72 hours) after vein treatment.
You can find LCDs for different geographic regions following the link below (choose your geographic region, type varicose veins in the search box, for outpatient coverage use MAC Part B):