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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 Phlebectomy: 
 
Stab phlebectomy also referred to as stab avulsion, phlebectomy, ambulatory stab phlebectomy, or 
microphlebectomy is a surgical treatment involving the removal of varicose veins through small stab 1-2 mm 
incisions in the skin overlying the vein. The vein is hooked and brought to the surface at each incision site to 
release it from the surrounding tissues and to sever any connections to other veins. Transilluminated powered 
phlebectomy (Trivex) should be billed as a phlebectomy and can be covered if it meets indications as outlined 
for phlebectomy. 
 
Phlebectomy is an adjunctive procedure and may be covered for patients with symptomatic varicose tributary 
veins for those with C2 and VCSS >6, or C2 and VCSS <6 with documentation of the failure of compression 
therapy, or patients with C3-C6 disease, ideally at the same time or following surgical or thermal ablation 
treatment of the saphenous veins, as outlined in the plan of care that addresses the episode of care. If treatment 
does not meet the Medicare reasonable and necessary threshold for coverage, claims billed for this procedure 
will be denied. 
 
Limitations 
 
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural 
road mapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage 
(e.g., congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) is 
not applicable (incorrect coding) for saphenous ablation and is not covered.  
 
Ultrasound guidance for needle placement has limited coverage by qualified physicians for image-guided foam 
sclerotherapy, as outlined in this LCD. 
 
Thermal ablation includes the necessary ultrasound imaging for any additional procedures done with the 
thermal ablation. 
 
Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, 
documentation of selected vessel patency, concurrent real-time ultrasound visualization of vascular needle 
entry, with permanent recording and reporting is not a covered service for outpatient varicose vein procedures. 
 
Local anesthesia and minimal to no sedation is the standard of care. Monitored Anesthesia Care (MAC) or 
moderate (conscious) sedation needs clear support in the medical record based on patient clinical 
presentation/characteristics and may be subject to prepayment review. 
 
Providers are required to code to specificity. If no such procedure of service exists, then report the service 
using the appropriate unlisted procedure code. 
 
 
 
 
If it is determined on review that the varicose veins were asymptomatic, the claim will be denied as a non-
covered (cosmetic) procedure. Isolated injections for the treatment of telangiectasias and reticular veins less 
than 3mm in diameter are considered cosmetic and do not meet the Medicare reasonable and necessary 
threshold for coverage. Claims billed for these procedures will be denied. 
 
As published in the CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 
13.5.4, an item or service may be covered by a contractor LCD if it is reasonable and necessary under the 
Social Security Act Section 1862 (a)(1)(A). Contractors shall determine and describe the circumstances under 
which the item or service is considered reasonable and necessary. 
 
You can find this information in Medicare's FUTURE RETIRED Local Coverage Determination (LCD): 
Treatment of varicose veins of the lower extremity (L33762). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.