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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:  
o Presence and Patency of the Deep Venous System. 
o Absence of Deep Venous Thrombosis, and 
o 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. 
Services will be considered reasonable and necessary only if performed by appropriately trained personnel. 
o Endovenous Radiofrequency and Laser Ablation Occlusion Therapy (ERFA) (EVLT) are 
minimally invasive alternatives to ligation and stripping. Multiple System devices are FDA approved 
for endovascular coagulation and closure of large veins in the lower extremities including the 
saphenous veins at the saphofemoral and saphopopliteal junctional regions. It is the responsibility of the 
treating physician to determine and insure FDA approval of the device employed for the specific vein 
obliteration planned. To be considered for coverage of these procedures, all of the following criteria 
must be met: 
1. Patient's anatomy is amenable to laser or radiofrequency catheter with the absence of tortuosity that 
would impair catheter passage and distance separation from skin as to preclude thermal injury. Unless 
documented by the supplier of the RFA or LA device, maximal vein diameter may not exceed 20mm as 
there is insufficient data to suggest devices presently marketed for this purpose are effective for 
occlusion of veins above this diameter. 
2. Non-Aneurysmal Saphenous vein or portion of vein at risk of rupture, hemorrhage or adjacent skin 
injury. Large veins adjacent to aneurysm formation (fusion of skin and vein wall) are optimal 
candidates for ERFA or EVLT in that adjacent aneurysm and preclude further need for treatment. 
3. Maximal vein diameter is clinically appropriate for catheter or sheath employed. 
4. No planned treatment of incompetent valves or risk of direct injury to perforator veins of the calf that 
may induce thrombus propagation into the deep vein system. 
5. Absence of clinically significant or symptomatic peripheral arterial disease. 
 
You can find this rule in the Local Coverage Determination for Treatment of Varicose Veins and Venous Stasis 
Disease of the Lower Extremities, L34924 (eff 11/14/19). 
 
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.