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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 The CEAP classification for chronic venous disorders was developed by an international committee that classifies venous disease according to the clinical manifestations (C), etiologic factors (E), anatomic distribution of disease (A), and underlying pathophysiologic findings (P), or CEAP.8 Advanced CEAP: Same as basic CEAP, with addition that any of 18 named venous segments can be used as locators for venous pathology. The Venous Clinical Severity Score (VCSS): The VCSS system includes 10 clinical descriptors (pain, varicose veins, venous edema, skin pigmentation, inflammation, induration, number of active ulcers, duration of active ulceration, size of ulcer, and compressive therapy use), scored from 0 to 3 (total possible score, 30) that may be used to assess changes in response to therapy. The plan of care, for a 90 day episode of care, is based on the treating physician's assessment. The minimum evaluation that must be documented includes the history, physical examination, CEAP clinical classification, VCSS, and a venous duplex scan documenting the venous flow. Supplemental plethysmography, contrast venography, venous pressure measurements, intravascular ultrasound (IVUS), computed tomography (CT) venography, or magnetic resonance (MR) venography may be relevant to the plan of care in patients with severe or unusual presentations of venous disease in which there is possible concurrent involvement of pelvic veins or arterial-venous malformations or fistulae. Indications for these more extensive procedures should be documented in the plan of care. Covered Indications: 1. Invasive procedures will be considered medically reasonable and necessary if the patient meets the criteria as outlined in this LCD, and the intervention is addressed and supported in the plan of care, for a 90 day episode of care, that includes a specific treatment plan determined by the assessment and evaluation of the lower extremity venous incompetence. 2. Invasive procedures for the treatment of varicose veins are considered medically reasonable and necessary when ALL of the following criteria have been met: An evaluation of the patient has been performed including a history and physical examination, the CEAP clinical classification and the revised Venous Clinical Severity Score (VCSS), AND; A duplex scan of the deep and superficial venous systems supports the examination findings,3 AND; A duplex scan confirms the presence of reversed venous flow (reflux) with provocative maneuvers in the saphenous, or perforator veins is 500 milliseconds or greater and absence of deep venous obstruction, AND; The documentation supports signs and/or symptoms that interfere with activities of daily living and/or quality of life, AND; The CEAP clinical classification is C1 to C6 with the following criteria: Treatment of C1 disease (telangiectasia and their feeding reticular veins) is considered medically reasonable and necessary for patients with spontaneous and/or traumatic venous hemorrhage. For patients with C2 or C3 disease and VCSS less than 6, the plan of care shall include documentation of a period of conservative therapy (2 to 4 weeks) including graduated compression 20-30 mmHg or greater, ambulation, elevation, and avoiding prolonged sitting and standing. For patients who meet any one of the following criteria, the mandatory conservative therapy prior to the invasive procedure may be waived. VCSS equals 6; C4-C6 disease (skin changes assigned to venous disease, healed venous leg ulceration, and active venous leg ulceration); Hemorrhage; Recurrent superficial thrombophlebitis. 3. Incompetent perforator vein (IPV) management by foam sclerotherapy or thermal ablation, will be considered medically reasonable and necessary when: An active venous ulcer is in close proximity to the IPV, OR; The proximal significant reflux has been treated and an IPV persists under or adjacent to a healed venous ulcer, OR; The proximal and regional venous reflux has been treated and there is persisting focal pain and tenderness or stasis dermatitis overlying an IPV, OR; The incompetent perforator demonstrates reflux greater than 500 ms and diameter greater than 3.5 mm. 4. Ultrasound guided foam sclerotherapy (UGFS), physician-compounded foam (PCF) and non-compounded foam (NCF) will be considered medically reasonable and necessary for ablation of incompetent saphenous veins and tributary veins for the treatment of patients with symptomatic CEAP clinical classification C2 to C6 disease. UGFS is also considered medically reasonable and necessary for
ablation of venous malformations. 5. Liquid sclerotherapy will be considered medically reasonable and
necessary for ablation of incompetent saphenous veins and tributary veins for the treatment of patients with
symptomatic CEAP clinical classification C2 to C6 disease. Liquid sclerotherapy is also considered medically
reasonable and necessary for the treatment of patients with symptomatic CEAP clinical classification C1
(telangiectasia and their feeding reticular veins) with spontaneous and/or traumatic venous hemorrhage. 6.
Thermal ablation (radiofrequency or laser) will be considered medically reasonable and necessary for ablation
of incompetent saphenous veins for the treatment of patients with symptomatic CEAP clinical classification C2
to C6 disease. 7. Chemical adhesives will be considered medically reasonable and necessary for ablation of
incompetent saphenous veins for the treatment of patients with symptomatic CEAP clinical classification C2 to
C6 disease. 8. Mechanochemical ablation (MOCA) will be considered medically reasonable and necessary for
ablation of incompetent saphenous veins for the treatment of patients with symptomatic CEAP clinical
classification C2 to C6 disease. 9. It is the responsibility of the provider to comply with all applicable State and
Federal laws related to the human use of agents. 10. Surgery will be considered medically reasonable and
necessary for treatment of incompetent saphenous veins for patients with symptomatic CEAP clinical
classification C2 to C6 disease. 11. Phlebectomy will be considered medically reasonable and necessary for
symptomatic bulbous varicosities greater than 3mm diameter above and below the knees. If saphenous vein
ablation is performed, phlebectomy may be staged or concomitant depending upon the vein pattern and/or
provider preferences. Limitations: The following are considered not medically reasonable and necessary: 1.
The treatment of CEAP clinical classification C0 (no visible or palpable signs of venous disease) is considered
cosmetic, and therefore, not reasonable and necessary for the purposes of Medicare coverage. 2. The treatment
of CEAP clinical classification C1 (telangiectasias or reticular veins) will be considered cosmetic, and
therefore, not reasonable and necessary for the purposes of Medicare coverage except in patients with
spontaneous and/or traumatic venous hemorrhage. Notice: Services performed for any given diagnosis must
meet all of the indications and limitations stated in this LCD, the general requirements for medical necessity as
stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all
Medicare payment rules. You can find this information in Medicare's Local Coverage Determination (LCD):
Treatment of Chronic Venous Insufficiency of the Lower Extremities (L38720).

If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.