Miscellaneous Treatment for Varicose Veins/Venous Insufficiency Medical Policy #: 02.01.54 Original Effective Date: August 2014 Reviewed: May 2022 Revised: May 2022 NOTICE: This policy contains information which is clinical in nature . Medical Policies are used as guidelines for coverage determinations in health care benefit programs, unless otherwise indicated. At 3 months post treatment, only 15.2% of the treated limbs had varicose veins present. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. Ligation and Stripping and Phlebectomy (i.e., Stab, Hook, Transilluminated Powered): The traditional treatment of varicose veins in the lower legs includes a surgical procedure called high ligation and saphenous vein stripping (HL/S). Medical Policies and Coverage Home Providers Provider Medical Policies and Coverage Effective March 15, 2022, medical drug policies will permanently move from this page to the Prior Review and Limitations page. Joint Medical Policies are a source for BCBSM and BCN medical policy information only. Varicose Vein Treatment: Published: 03/01/2022. The treatment of asymptomatic varicose veins, or symptomatic varicose veins without a 3-month trial of conservative measures, by any technique will be considered cosmetic and therefore not covered. View Medical Policies In adult western populations visible varicose veins are present in 20 to 25 % of women and 10 to 15 % of men. . To find out what is covered under your specific plan, please view your SPD or contact Boeing Member Services at 888-802-8776. Blue Cross and Blue Shield of Texas, a Division of . 37718 . Phlebectomy, also known as stab phlebectomy, ambulatory phlebectomy, or microphlebectomy, involves the removal of secondary smaller veins as the removal of the varicose veins are through a small 1-2 mm incision in the skin overlying the vein. Varicose veins result from weakening or incompetence of a one-way valve, leading to reflux (i.e., reverse flow) of blood in the vessel. Recurrent or residual varicose vein post varicose vein procedure . Blue Cross/BCN Medical Policy Echosclerotherapy for the Treatment of Varicose Veins, effective May 1, 2022 . A second component of treatment is elimination of the superficial varices, which are the visible component of the condition. Policy #: 045 Latest Review Date: May 2017 Changes and effective dates. If the member's contract benefits differ from the medical policy, the contract prevails. Author: Blue Cross/BCN . 1.01.09 Transcutaneous Electrical Nerve Stimulation. Talk to your insurance provider for details about your coverage. Varicose veins is a medical condition that appears in 60 percent of adults. Some employers have chosen not to cover varicose vein treatment specifically, so be sure and check with your human resources department or call the toll-free number on the back of your insurance card. 37780 . The Health Plan has adopted eviCore's medical policies and guidelines as a basis for the determination of medical necessity and appropriateness of care. Medical Policies The policies contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. 1.01.15 Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions. Title: Varicose vein tx, adults: Authorization criteria . The number of legs with varicose veins increased to 40.7% at 5 years. 104 Varicose Vein Treatment Effective: September 1, 2022 Next Review: March 20 2 3 Last Review: August 2022 . It is inappropriate to report CPT code 37241 for the treatment of superficial varicose veins of the lower extremity. Medical Policy An Independent licensee of the Blue Cross Blue Shield Association Title: Varicose Veins Professional Institutional . An initial vein occlusion rate of 100% was reported. This Coverage Policy addresses varicose vein treatment. POLICY LAST UPDATED: 07|07|2021 . A variety of treatment modalities are available to treat varicose veins/venous insufficiency, including surgical approaches, thermal ablation, and sclerotherapy. Federal Employee Program (FEP) plans - Go to FEPblue.org > Policies & Guidelines. Policy #: 045 Latest Review Date: January 2014 Category: Surgery Policy Grade: B . 5. *Medical Policy Documentation Form Available - Click on Link . Varicose veins with visible varicosities may be the only sign of venous reflux, although itching . Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg 37765 Stab phlebectomy of varicose veins, one extremity; 10-20 stab incisions 37766 Stab phlebectomy of varicose veins, one extremity; more than 20 incisions 37780 Ligation and division of short saphenous vein at saphenopopliteal junction These policies are shared for information only, but the health plan decides how they apply. Proprietary Information of Blue Cross and Blue Shield of Alabama An Independent Licensee of the Blue Cross and Blue Shield Association Blue Advantage Medical Policy #045 . Medicare Part C Medical Coverage Policy Varicose Vein Treatment Origination Date: June 1, 1993 Review Date: May 18, 2022 Next Review: May, 2024 ***This policy applies to all Blue Medicare HMO, Blue Medicare PPO, Blue Medicare Rx members, and members of any third-party Medicare plans supported This website is owned and operated by USAble Mutual Insurance Company, d/b/a Arkansas Blue Cross and Blue Shield. In most persons, varicose veins do not cause symptoms other than poor cosmesis. Yes No Is one of the following treatments a component of the treatment for symptomatic varicose tributaries when performed either at the same time or following prior treatment . BlueCard (Out-of-Area) plans - Access information from other BCBS Plans through the secure provider portal at "Practice Management > Medical Policies > BlueCard (Out of-Area) Members". Accepting New Patients Varicose Vein Procedures near Baytown, TX 13 Results All Results JN Dr. Jacobo Nurko, MD General Surgery, Vascular Surgery 29 20 Years Experience 4301 Garth Rd Ste 212,. The proposed new and revised Medical policies will become effective 90 calendar days from the date listed on the bulletin. June 2021 BCBS Massachusetts Medical Policy Updates: Artificial Intervertebral Disc - Cervical Spine. Assisted Reproductive Services Infertility Services. 01/01/2016. The patient must have ONE of the following: . In addition to the active and pending Medical Policies, BCBSIL has included policies which are under development or being revised. treatment of varicose veins/venous insufficiency at the time of superficial vein procedures. 00034 Treatment of Varicose Veins/Venous Insufficiency; 00557 Select Drugs for Constipation; 00391 Tumor Treating Fields Therapy; 00128 T-Wave Alternans- Retired Policy; . Blue Cross and Blue Shield Kansas is an independent licensee of the Blue Cross Blue Shield Association . Name of Blue Advantage Policy: Management of Varicose Veins . These policies may change to stay up to date with current research and a posted policy may not reflect a recent change. Wellmark Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield . Background/Definitions: As a general rule, benefits are payable under Blue Cross and Blue Shield of Alabama health Effective February 26, 2018. They are often used as guidelines for coverage determinations in health care benefit programs. CPT codes with an indicator of 2 allow an assistant. Search by keyword or procedure code for related policy information. Varicose vein surgery is one of the most commonly performed cosmetic procedures in the United States. Please refer member-specific questions to the Customer Care number on the back of the member ID card. They have guidelines that are plan specific, which allow payment based on medical necessity. Varicose Vein Management - SUR707.016* Vertebral Disc Replacement with Artificial Disc - SUR712.028 . Upcoming policies effective December 5, 2022 (PDF) Upcoming policies effective October 31, 2022 (PDF) Upcoming policies effective October 3, 2022 (PDF) Upcoming policies effective September 5, 2022 (PDF) Upcoming policies effective August 1, 2022 (PDF) Upcoming policies effective July 4, 2022 (PDF) services described in Blue Cross and Blue Shield of Texas (BCBSTX) Medical Policies. Final determination of coverage is subject to the member's benefits and eligibility on . Blue Shield of California Reproduction without authorization from 601 12th Street, Oakland, CA 94607 Blue Shield of California is prohibited Medical Policy An i ndependent m ember of the Blue Shield Association C. 7.01.124 Treatment of Varicose Veins/Venous Insufficiency Original Policy Date: October 11, 2000 Effective Date: July 1, 2022 . For example, if the patient has pain, which is worsening and affecting their activities of daily living. Name of Policy: Management of Varicose Veins . Mailing Address. View Medical Policies About Medical Policies & Clinical UM Guidelines Other Criteria Associated Dates Contact Us When fewer than 10 incisions are required, report code . MCG care guidelines - Call BCBSAZ at 1-800-446-8331. Insurance coverage is always dependent upon benefit eligibility, as outlined in your specific benefit plan. 06/2003, Blue Shield pays for specific treatments of symptomatic varicose veins, treatment of spider veins not covered . 1.01.05 Low Intensity Pulsed Ultrasound Fracture Healing Device. 208-286-3588. The Blue Cross and Blue Shield of Minnesota (Blue Cross) medical and behavioral health policy team develops evidence-based medical and behavioral health policies. BCBSTX Clinical Payment and Coding Policies are based on criteria developed by specialized professional societies, national guidelines (e.g., Milliman Care Guidelines) and the CMS Provider Reimbursement Manual. Please forward any questions or comments regarding proposed new or revised medical policies to TexasMedicaidNetworkDepartment@bcbstx.com . References to CPT codes 76942, 93965, 93970 and 93971 were removed from the "Coding Information" and "CPT/HCPCS Codes" sections. For the treatment of all other conditions than those specified above. 37765 Stab phlebectomy of varicose veins, 1 extremity; 10 - 20 stab incisions 37766 Stab phlebectomy of varicose veins, one extremity; more than 20 incisions 37780 Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) 37785 Ligation, division, and/or excision of varicose vein cluster(s), 1 leg 37700 . OVERVIEW . Ablation, Endovenous, Varicose Vein . FEP 7.01.124 Treatment of Varicose Veins/Venous Insufficiency Effective Policy Date: October 1, 2019 Original Policy Date: December 2011 Related Policies: None Treatment of Varicose Veins/Venous Insufficiency Description A variety of treatment modalities are available to treat varicose veins/venous insufficiency, including surgery, thermal . treatment of varicose veins, the denial not only includes treatment but also the associated venous imaging studies (i.e. . Spider veins (also known as telangiectases) have a web-like appearance on the surface of the skin. The individual has ANY ONE of the following:; o Documented limitations of activities of daily living caused by persistent lower extremity symptoms such as . Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions. Refer to the Non-Invasive Vascular Studies LCD (L33627) for coverage . Enter one or more keyword (s) for desired policy or topic. May 2021 BCBS Michigan Medical Policy Updates: Accelerated Breast Irradiation after Breast-Conserving Surgery for Early Stage Breast Cancer and Breast Brachytherapy as Boost with Whole-Breast Irradiation Aqueous Shunts and Stents for Glaucoma Automated Point-of-Care Nerve Conduction Tests Please submit all requests for the affected medical drugs via the CMM Portal or fax to 1-888-348-7332. However, when com-bined superficial vein procedures and compression therapy have failed to improve symptoms (i.e., ulcers), treat-ment of perforator vein reflux may be as beneficial as an alternative (e.g., deep vein valve replacement). Artificial Intervertebral Disc - Lumbar Spine. Proprietary Information of Blue Cross and Blue Shield of Alabama Medical Policy #045 . FEP 7.01.124 Treatment of Varicose Veins/Venous Insufficiency Effective Policy Date: October 1, 2020 Original Policy Date: December 2011 Related Policies: None Treatment of Varicose Veins/Venous Insufficiency Description A variety of treatment modalities are available to treat varicose veins/venous insufficiency, including surgery, thermal . BCBSNE follows CMS's Post-Op and Assistant Surgery Policy. ALL of the general medically necessary criteria above outlining when treatment for symptomatic varicose veins is eligible for reimbursement are met. 36479 . Requests directly related to medical policy content or requests for clinical criteria may be sent to the Medical Policy Operations Specialist via email, fax, phone or mail. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomised trial of stripping the long . For medical policies for other Blue plans, use the Medical Policy & Pre-Cert/Pre-Auth Router. (2018) published the 5-year outcomes of an RCT consisting of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins comparing surgery and endovenous laser ablation (EVLA) as treatments for symptomatic great saphenous varicose veins. The medical director of Arkansas Blue Cross and Blue Shield has established specific coverage policies addressing certain medical procedures or technologies. BCBSTX Medical Policies and BCBSTX Clinical Payment and Coding Policies Blue Cross and Blue Shield of Texas (BCBSTX) Medical Policies are based on scientific and medical research. Next Review: 03/ 202 3 . Medical Policy . 36476 . Treatments for Varicose Veins Fax or mail thiscompleted form For Pre-Service: Statewide Fax (877) 219-9448. Fax. CPT 93970 or 93971) for treatment planning. The treatment of spider veins or superficial telangiectasis by any technique is considered cosmetic, and therefore not covered. Management of Varicose Veins ; Manipulation under Anesthesia for Treatment of Chronic Spinal or Pelvic Pain; Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders ; Measurement of Long-Chain Omega-3 Fatty Acids in Red Blood Cell Membranes as a Cardiac Risk Factor Blue Cross of Idaho. Please refer to Medical Policy Bulletin, S-100, for information on Multiple Surgical Procedures. Superficial reticular veins and/or telangiectasias; B. 25 Covered Indications The Medicare Advantage Medical Policy manual is not intended to override the member Evidence of Coverage (EOC), which . This is why most insurance plans cover treatment. 4. They are often used as guidelines for coverage determinations in health care benefit programs. Local: 986-224-3249. (VAS) for pain, the Varicose Vein Severity Score (VCSS), and the Aberdeen Varicose Veins Questionnaire (AVVQ).AVVQ scores range from 0 to 100 (worst possible quality of life).Follow-up at one and two years from RCTs is of interest to . The first step is elimination of the refluxing saphenous vein using either ligation and stripping, or endovenous radiofrequency or laser ablation. Policy Replaced by LCD L33454 . Medical Policy Manual Surgery, Policy No. 1.01.17 Pelvic Floor Stimulation as a Treatment of . Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas. By clicking on "I Accept" below, I acknowledge that I can read and that I have read and accept . Medicare Link(s) Revised: 03/01/2022. These HCSC Medical Policies apply only to members who have health insurance through the Blue Cross and Blue Shield plans of Illinois, Montana, New Mexico, Oklahoma, and Texas or who are covered by a self-insured group . Its primary goal is removal of refluxing veins and improvement of symptoms. Starting July 1, 2020, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will no longer require prior plan approval for the treatment of varicose veins for medically-appropriate indications. These guidelines are available to you as a reference when interpreting claim decisions. . Treatment for symptomatic varicose veins may be considered medically necessary when ALL of the fol lowing criteria are met for all varicose vein treatments:. The primary difference between spider veins and varicose veins is that spider veins lack varicose vein symptomatology. Phone. P.O. - Plan of care for treatment of the varicose vein(s) Section 5: Read this important information . Varicose veins are a common condition. The term "varicose veins" does not include telangiectatic dermal vessels (e.g., "spider veins" or "broken blood vessels"). To view the out-of-area Blue Plan's medical policy or general pre-certification/prior authorization information, please select the type of information requested, enter the first three characters of the member's identification number on the Blue Cross Blue Shield ID card, and click "GO." . The purpose of a Coverage Policy is to inform members and their physicians why certain medical procedures may or may not be covered under Arkansas Blue Cross and Blue Shield health plans. Key Points: Box 1798. . 37722 . revised 05/2010 . IMPORTANT REMINDER . Answered by Advanced Varicose Veins Treatments of Manhattan (View Profile) Blue Cross plans do often pay for varicose vein procedures. Com- Last Review: 01 /2022. General medical necessity criteria for coverage of symptomatic varicose veins. CPT codes with indicators 0, 1, and 9 in the assistant surgery column do not allow payment for assistant surgeon. Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Page 1 of 1 Varicose Vein Management Varicose Vein Management Medical Policy - SUR707.016 Please complete all appropriate questions fully. III. Ambulatory phlebectomy services, procedures codes 37765 and 37766, are reported based on the number of incisions performed on each extremity. 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 1 (401) 274-4848 WWW.BCBSRI.COM. Email. Varicose veins were present in 98.6% of legs at baseline with 52.2 originating from the GSV. - Activities the patient must modify or eliminate due to pain and swelling caused by varicose veins. Aside from the discomfort, unhealthy veins can lead to more serious medical problems, like ulcers. 36478 . As you review medical policies, please consider the following: Medical policies are written for physicians and may be highly technical and complex. Methods of treatment that been investigated and proven effective for the treatment of varicose veins include ambulatory phlebectomy, ligation A. Asymptomatic varicose veins 1. Suggested medical record documentation: Blue Cross and Blue Shield of Louisiana Medical Policy Coverage Guidelines. Additional sources are used and can be provided upon request. Corporate Medical Policy Page 1 of 17 An Independent Licensee of the Blue Cross and Blue Shield Association Varicose Veins of the Lower Extremities, Treatment for File Name: varicose_veins_of_the_lower_extremities_treatment_for 12/2000 11/2021 11/2022Next CAP Review: 11/2021 Origination: Last CAP Review: Last Review: Description of Procedure or . Wallace et al. The team presents medical and behavioral health policies to the Blue Cross Medical and Behavioral Health Policy Committee and the Blue Cross Medical Pharmacy & Therapeutics Committee . 36475 . These Medical Policies serve as guidelines for health care benefit coverage decisions, which may vary according to the different products and benefit plans offered by BCBSIL. The purpose of this policy is to provide general information applicable to the administration of health benefits that Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare of New Jersey, Inc. (collectively "Horizon BCBSNJ") insures or administers. It is the policy of health plans affiliated with Centene Corporation that cyanoacrylate adhesive (e.g. Treatment of symptomatic varicose veins typically involves two components. Varicose veins may be treated by sclerotherapy or surgical ligation . Medical notes documenting the following, when applicable: Diagnosis History of the medical condition(s) requiring treatment or surgical intervention R3. Title: These policies address situations that occur frequently and some situations may warrant further individual review. To filter medical policies, begin typing the policy name or number: View All. For Post-Service Claims: Florida Blue. - The conservative management the patient has attempted to control pain and swelling, including the outcome. All other available Medical Policy documents are published by policy/topic title. . BCBSTX Medical Policies and BCBSTX Clinical Payment and Coding Policies Blue Cross and Blue Shield of Texas (BCBSTX) Medical Policies are based on scientific and medical research. 16 Data from 218 patients were available at 5-year follow . HCOMedicalPolicy@bcidaho.com. They are provided here for informational purposes only. EFFECTIVE DATE: 05|01|2019. They are not intended to replace or substitute for the independent medical judgment of a practitioner or other health care professional in the treatment of an individual member. Service Resource(s) Last Reviewed / Approved; Asthma: 2007 National Heart, Lung, and Blood Institute (NIH) EPR-3 Guidelines for the Diagnosis and Management of Asthma (includes: 2008 edits to the 2007 guideline): Last reviewed 7/2022: Back Pain: 2017 American College of Physicians (ACP) Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline If the CMS indicator is 0 and the service is denied, you may submit an appeal along with the appropriate medical . VenaSeal) is considered investigational for the treatment of varicose veins.
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