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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 sclerosant used in sclerotherapy procedures is included in the procedure code and is not 
separately reported. 
 
Liquid sclerotherapy is reported using CPT codes 36468, 36470, and 36471. Non-compounded foam (NCF) 
sclerotherapy, for treatment of other incompetent extremity veins, is reported using CPT codes 36470 and 
36471. Physician-compounded foam (PCF) sclerotherapy, for treatment of incompetent extremity truncal veins 
and other incompetent extremity veins, is reported using CPT codes 36470 and 36471. you can find these rules 
in the Local Coverage Article Billing and Coding Billing and Coding: Treatment of Chronic Venous 
Insufficiency of the Lower Extremities A55229. 
 
The rules say Chronic Venous Insufficiency (CVI) is a cause of abnormalities of the venous system producing 
edema, skin changes, or venous ulcers that is associated with varicose veins. Varicose veins of the lower 
extremities are a manifestation of chronic venous disease (CVD) and are a common disorder in the United 
States. They are dilated subcutaneous veins that are greater than or equal to 3 millimeters in diameter and have 
reflux >500 milliseconds in an upright position. They may be caused by primary venous disease with local or 
multifocal structural weakness of the vein wall leading to valvular insufficiency or valvular reflux. Secondary 
causes include a previous deep vein thrombosis, a deep venous obstruction, superficial thrombophlebitis, an 
arteriovenous fistula, or a congenital venous malformation. Varicosities are frequently the cause of discomfort, 
pain, disability and deterioration of health-related quality of life (QOL). 
 
Clinical outcome studies evaluate the results of procedures on patient-focused outcomes, including symptom 
improvement, recurrence of varicosity, healing or recurrence of skin ulcers, improvement in the chronic, 
progressive symptoms of CVD/CVI, improved QOL and improved activities of daily living. Patient outcome 
assessments or quality of life instruments can be measured before and after treatment. Below are some 
examples (not all inclusive) of the validated assessment tools: 
 
    AVVQ: Aberdeen Varicose Vein Questionnaire 
    HASTI: (heaviness, achiness, swelling, throbbing, itching) score 
    Veines-QOL: Venous Insufficiency Epidemiological and Economic Study-Quality-of-Life/Symptoms     CIVIQ-20: Chronic Venous Insufficiency Quality-of-Life Questionnaire 
 
Superficial, deep and perforating veins make up the lower extremity venous system. Superficial veins, which 
are located between the deep fascia and the skin, include the telangiectasia veins, the reticular veins and the 
main axial (truncal) superficial veins, the great and small saphenous veins and their tributaries. Deep veins, 
which lie beneath the muscular fascia, include the following: inferior vena cava, common iliac, internal iliac, 
external iliac, pelvic, gonadal, broad ligament, common femoral, deep femoral, femoral, popliteal, crural 
(anterior tibial, posterior tibial, or peroneal), and muscular (gastrocnemius, soleus and other). Perforating veins, 
which penetrate the muscular fascia and connect the superficial and deep veins, include numerous veins from 
those of the foot, the medial and lateral calf, and the thigh. 
 
Telangiectasia veins (also known as spider veins) are small, dilated, flat, thin-walled, blue or red veins <1 
mm in diameter that are seen near the surface of the skin. Reticular veins are a network of veins parallel to the 
skin surface and lying between the saphenous fascia and dermis, which drain the lower extremity skin and 
subcutaneous tissue and have a diameter 1-3 mm (also known as blue veins or feeder veins). You can find these 
rules in the Local Coverage Determination (LCD) Treatment of Chronic Venous Insufficiency of the Lower 
Extremities L34924. 
 
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.