Recurrent or residual varicose vein post varicose vein procedure . 4. 1.01.15 Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions. Please submit all requests for the affected medical drugs via the CMM Portal or fax to 1-888-348-7332. 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) Next Review: 03/ 202 3 . As you review medical policies, please consider the following: Medical policies are written for physicians and may be highly technical and complex. This is why most insurance plans cover treatment. Title: Varicose vein tx, adults: Authorization criteria . Com- EFFECTIVE DATE: 05|01|2019. Additional sources are used and can be provided upon request. Policy Replaced by LCD L33454 . Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. MCG care guidelines - Call BCBSAZ at 1-800-446-8331. It is inappropriate to report CPT code 37241 for the treatment of superficial varicose veins of the lower extremity. References to CPT codes 76942, 93965, 93970 and 93971 were removed from the "Coding Information" and "CPT/HCPCS Codes" sections. 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". treatment of varicose veins, the denial not only includes treatment but also the associated venous imaging studies (i.e. Wellmark Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield . Blue Cross and Blue Shield Kansas is an independent licensee of the Blue Cross Blue Shield Association . An initial vein occlusion rate of 100% was reported. These policies may change to stay up to date with current research and a posted policy may not reflect a recent change. 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." . Artificial Intervertebral Disc - Lumbar Spine. Varicose veins were present in 98.6% of legs at baseline with 52.2 originating from the GSV. Joint Medical Policies are a source for BCBSM and BCN medical policy information only. June 2021 BCBS Massachusetts Medical Policy Updates: Artificial Intervertebral Disc - Cervical Spine. 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. 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 The treatment of spider veins or superficial telangiectasis by any technique is considered cosmetic, and therefore not covered. Varicose veins result from weakening or incompetence of a one-way valve, leading to reflux (i.e., reverse flow) of blood in the vessel. Federal Employee Program (FEP) plans - Go to FEPblue.org > Policies & Guidelines. The term "varicose veins" does not include telangiectatic dermal vessels (e.g., "spider veins" or "broken blood vessels"). 37718 . Title: These policies are shared for information only, but the health plan decides how they apply. These guidelines are available to you as a reference when interpreting claim decisions. Treatments for Varicose Veins Fax or mail thiscompleted form For Pre-Service: Statewide Fax (877) 219-9448. 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). The Blue Cross and Blue Shield of Minnesota (Blue Cross) medical and behavioral health policy team develops evidence-based medical and behavioral health policies. Blue Cross/BCN Medical Policy Echosclerotherapy for the Treatment of Varicose Veins, effective May 1, 2022 . 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. These policies address situations that occur frequently and some situations may warrant further individual review. . 16 Data from 218 patients were available at 5-year follow . 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 1 (401) 274-4848 WWW.BCBSRI.COM. 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 . services described in Blue Cross and Blue Shield of Texas (BCBSTX) Medical Policies. This Coverage Policy addresses varicose vein treatment. Blue Cross and Blue Shield of Texas, a Division of . View Medical Policies 36476 . Search by keyword or procedure code for related policy information. Email. Varicose veins may be treated by sclerotherapy or surgical ligation . Name of Blue Advantage Policy: Management of Varicose Veins . Varicose veins are a common condition. . Key Points: 104 Varicose Vein Treatment Effective: September 1, 2022 Next Review: March 20 2 3 Last Review: August 2022 . The number of legs with varicose veins increased to 40.7% at 5 years. Varicose Vein Treatment: Published: 03/01/2022. A variety of treatment modalities are available to treat varicose veins/venous insufficiency, including surgical approaches, thermal ablation, and sclerotherapy. 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. 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. If the CMS indicator is 0 and the service is denied, you may submit an appeal along with the appropriate medical . R3. CPT codes with an indicator of 2 allow an assistant. The proposed new and revised Medical policies will become effective 90 calendar days from the date listed on the bulletin. The patient must have ONE of the following: . By clicking on "I Accept" below, I acknowledge that I can read and that I have read and accept . Methods of treatment that been investigated and proven effective for the treatment of varicose veins include ambulatory phlebectomy, ligation General medical necessity criteria for coverage of symptomatic varicose veins. 36479 . At 3 months post treatment, only 15.2% of the treated limbs had varicose veins present. P.O. Its primary goal is removal of refluxing veins and improvement of symptoms. Refer to the Non-Invasive Vascular Studies LCD (L33627) for coverage . Superficial reticular veins and/or telangiectasias; B. For the treatment of all other conditions than those specified above. In most persons, varicose veins do not cause symptoms other than poor cosmesis. Medical Policy . Please refer member-specific questions to the Customer Care number on the back of the member ID card. 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 . 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 . The Medicare Advantage Medical Policy manual is not intended to override the member Evidence of Coverage (EOC), which . 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 Insurance coverage is always dependent upon benefit eligibility, as outlined in your specific benefit plan. Varicose vein surgery is one of the most commonly performed cosmetic procedures in the United States. IMPORTANT REMINDER . 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. Final determination of coverage is subject to the member's benefits and eligibility on . They are provided here for informational purposes only. 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 . 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 Medical notes documenting the following, when applicable: Diagnosis History of the medical condition(s) requiring treatment or surgical intervention 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. 1.01.05 Low Intensity Pulsed Ultrasound Fracture Healing Device. Spider veins (also known as telangiectases) have a web-like appearance on the surface of the skin. Proprietary Information of Blue Cross and Blue Shield of Alabama Medical Policy #045 . Medical Policy An Independent licensee of the Blue Cross Blue Shield Association Title: Varicose Veins Professional Institutional . This website is owned and operated by USAble Mutual Insurance Company, d/b/a Arkansas Blue Cross and Blue Shield. Medical Policies are used as guidelines for coverage determinations in health care benefit programs, unless otherwise indicated. Changes and effective dates. 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 . 37700 . Enter one or more keyword (s) for desired policy or topic. 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 of Louisiana Medical Policy Coverage Guidelines. 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). It is the policy of health plans affiliated with Centene Corporation that cyanoacrylate adhesive (e.g. 1.01.09 Transcutaneous Electrical Nerve Stimulation. Varicose Vein Management - SUR707.016* Vertebral Disc Replacement with Artificial Disc - SUR712.028 . 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. 208-286-3588. Policy #: 045 Latest Review Date: May 2017 . Varicose veins is a medical condition that appears in 60 percent of adults. Assisted Reproductive Services Infertility Services. They are often used as guidelines for coverage determinations in health care benefit programs. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomised trial of stripping the long . Suggested medical record documentation: Last Review: 01 /2022. 5. The medical director of Arkansas Blue Cross and Blue Shield has established specific coverage policies addressing certain medical procedures or technologies. Ambulatory phlebectomy services, procedures codes 37765 and 37766, are reported based on the number of incisions performed on each extremity. A second component of treatment is elimination of the superficial varices, which are the visible component of the condition. A. Asymptomatic varicose veins 1. The first step is elimination of the refluxing saphenous vein using either ligation and stripping, or endovenous radiofrequency or laser ablation. 06/2003, Blue Shield pays for specific treatments of symptomatic varicose veins, treatment of spider veins not covered . 36475 . 25 Covered Indications 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 CPT codes with indicators 0, 1, and 9 in the assistant surgery column do not allow payment for assistant surgeon. 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 . . (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. Box 1798. . Blue Cross of Idaho. About Medical Policies & Clinical UM Guidelines Other Criteria Associated Dates Contact Us The primary difference between spider veins and varicose veins is that spider veins lack varicose vein symptomatology. Answered by Advanced Varicose Veins Treatments of Manhattan (View Profile) Blue Cross plans do often pay for varicose vein procedures. Policy #: 045 Latest Review Date: January 2014 Category: Surgery Policy Grade: B . Treatment for symptomatic varicose veins may be considered medically necessary when ALL of the fol lowing criteria are met for all varicose vein treatments:. 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.