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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that treatment for Symptomatic Chronic Venous Insufficiency or Varicose Veins (VV), in the 
absence of bleeding, phlebitis or skin necrosis, may be covered as medically necessary with: 
 
1. A documented 3-month trial of conservative therapy including graduated compression stockings with a 
minimum of (12-18 mmHg), weight reduction to BMI less than 35, therapeutic leg elevation, and an exercise 
program of calf muscle pumping activity with compression of the involved veins, which results in limited 
alteration/improvement of symptoms or findings without satisfactory endpoint, and: 
 
2. Duplex venous studies of the involved lower extremity(s), mapping size and course of the greater and lesser 
saphenous vein and prominent tributaries and demonstrating the: 
 
-Presence and Patency of the Deep Venous System 
-Absence of Deep Venous Thrombosis 
- 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. 
 
You can find this rule in Local Coverage Determination (LCD): Treatment of Varicose Veins and Venous 
Stasis Disease of the Lower Extremities (L34924) - Effective November 14, 2019. 
 
The rules say that sclerotherapy with injectable liquid or foam and compression is considered medically 
necessary for treatment of small to medium-sized veins (3-6mm in diameter) for persons who meet medical 
necessity criteria for varicose vein obliteration described above. Sclerotherapy, with or without sono guidance, 
is not considered effective for large veins greater than 6mm diameter or the main saphenous veins. 
Sclerotherapy has not been shown to be effective for treatment of persons with reflux at the saphofemoral 
junction or saphopopliteal junction. Medical literature supports the premise that these patients should be treated 
with ligation or division of the saphofemoral or saphopopliteal junction to reduce the rate of recurrence and 
incidence of propagation of clot to the deep venous systems of the leg and pelvis. You can find this rule in 
Local Coverage Determination (LCD): Treatment of Varicose Veins and Venous Stasis Disease of the Lower 
Extremities (L34924) - Effective November 14, 2019. 
 
The rules say that symptomatic improvement is the primary goal and indicator of outcome. Documentation of 
persistent vein patency without recurrent symptoms does not indicate the need for additional therapy. Doppler 
ultrasound or duplex scan may be required prior to the treatment to characterize the venous anatomy. 
Additional claims for Doppler ultrasound or duplex scans used for guidance or monitoring during sclerotherapy 
is not separately reimbursable. Subsequent ultrasound will be denied as not medically necessary. You can find 
this rule in Local Coverage Determination (LCD): Treatment of Varicose Veins and Venous Stasis Disease of 
the Lower Extremities (L34924) - Effective November 14, 2019. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.