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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 Indications: 
 
Medicare will consider interventional treatment of varicose veins (sclerotherapy, ligation with or without 
stripping, and endovenous radiofrequency or laser ablation) medically necessary if the patient remains 
symptomatic after a six-week trial of conservative therapy. The components of the conservative therapy 
include, but are not limited to: 
 
    weight reduction, 
    a daily exercise plan, 
    periodic leg elevation, and 
    the use of graduated compression stockings. 
 
The conservative therapy must be documented in the medical record. 
 
The patient is considered symptomatic if any of the following signs and symptoms of significantly diseased 
vessels of the lower extremities are documented in the medical record: 
 
    stasis ulcer of the lower leg, as above, 
    significant pain and significant edema that interferes with activities of daily living, 
    bleeding associated with the diseased vessels of the lower extremities, 
    recurrent episodes of superficial phlebitis, 
    stasis dermatitis, or 
    refractory dependent edema. 
 
Additional indications and limitations are discussed according to type of treatment. 
 
In addition to the requirement for failure of a six-week trial of conservative treatment and the symptoms 
described above, coverage of endovenous ablation therapy is limited to patients with: 
     a maximum vein diameter of 20 mm for laser ablation; 
    absence of thrombosis or vein tortuosity, which would impair catheter advancement; and 
    absence of significant peripheral artery disease. 
 
Radiofrequency/laser ablation is covered only for treatment of the lesser or greater saphenous veins to improve 
symptoms attributable to saphenofemoral or saphenopopliteal reflux. Coverage is only for FDA devices 
specifically approved for these procedures. 
 
Non-cosmetic sclerotherapy will also be covered if performed in conjunction with surgical ligation or stripping 
procedures in appropriately selected patients. 
 
Limitations: 
 
Duplex ultrasound is often used in conjunction with other non-invasive physiologic testing to define the 
anatomy and physiology of the varicose vein network prior to injection or surgical intervention. There is 
adequate evidence that the pre-procedural ultrasound is helpful, and Medicare will cover a pre procedure 
Duplex scan CPT code 93970 or 93971) used in conjunction with other non-invasive physiologic testing CPT 
code to determine the extent and configuration of the varicosities. CGS expects that these studies will be 
performed by the provider planning to provide the therapy. CGS will allow this study once per provider or 
provider group. Clinical experience supports the use of ultrasound during the sclerotherapy procedure, and 
evidence shows that the outcomes may be improved and complication rates may be minimized when ultrasound 
guidance is used. 
 
Medicare will cover intraoperative ultrasonic guidance in situations when it is medically necessary. 
 
Medicare includes payment for the ultrasound in the payment for the ERFA and laser ablation procedures. 
 
Cosmetic surgery is statutorily excluded from coverage by Medicare. The following interventional treatments 
are considered to be cosmetic and will be denied as such: 
 
    Interventional treatment of asymptomatic varicosities. 
    Treatment of telangiectases (36468). 
    Sclerotherapy for cosmetic purposes. 
 
Medicare cannot cover services which are not reasonable and necessary for the treatment of illness or injury or 
to improve the functioning of a malformed body member. The following interventional treatments are not 
considered medically reasonable or necessary and are denied as such: 
 
    Interventional treatment of symptomatic varicosities without documentation of a failed six week trial of 
conservative therapy. 
    Sclerotherapy for vessels larger than 4 mm in diameter. 
    Reinjection following recanalization or failure of vein closure without recurrent signs or symptoms. 
    Sclerotherapy of the saphenous vein at its junction with the deep system. 
    Noncompressive sclerotherapy. 
    Compressive sclerotherapy for large, extensive or truncal varicosities. 
    Sclerotherapy, ligation and/or stripping of varicose veins, or endovenous ablation therapy are not covered for 
pregnant women, or patients with the inability to tolerate compressive bandages or stockings; severe distal 
arterial occlusive disease; obliteration of deep venous system; an allergy to the sclerosant; or a hypercoaguable 
state. 
    Any interventional treatment that uses equipment or sclerosants not approved for such purposes by the FDA. 
    Laser ablation of veins with a diameter greater than 20 mm. 
    Endovenous ablation therapy in the presence of thrombosis or venous tortuosity which would impair catheter advancement. 
 
CPT codes 37760 and 37761 should not be reported in conjunction with CPT codes 76937, 76942, 76998 or 
93971. You can find this information in Medicare's Local Coverage Determination (LCD): Varicose Veins of 
the Lower Extremity, Treatment of (L34082). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.