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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. 
 
According to the CPT Professional edition code book, CPT codes 37241-37244 are used to describe vascular 
embolization and occlusion procedures excluding the ablation/sclerotherapy procedures for venous 
insufficiency/telangiectasia of the extremities/skin, which are reported using 36468, 36470, and 36471. For 
sclerosis of veins or endovenous ablation of incompetent extremity veins, see 36468-36479. CPT code 37241 
is not appropriate for reporting of vein ablation for the treatment of chronic venous insufficiency of the lower 
extremities and is incorrect coding. 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.1,2 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).3  
 
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.3 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 Questionnaire4 
    HASTI: (heaviness, achiness, swelling, throbbing, itching) score5     Veines-QOL: Venous Insufficiency Epidemiological and Economic Study-Quality-of-Life/Symptoms5 
    CIVIQ-20: Chronic Venous Insufficiency Quality-of-Life Questionnaire6 
 
Terminology of veins discussed within this LCD 
 
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.2,7 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).3,7,8 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.7 
 
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.2 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).2 
 
The axial superficial veins communicate with the deep venous system at different locations. The point where 
the great saphenous vein (GSV) joins the common femoral vein, the saphenofemoral junction (SFJ), is located 
proximally at the groin. The point where the small saphenous vein (SSV) joins the popliteal vein, the 
saphenopopliteal junction (SPJ), is typically located behind the knee. Clinically significant reflux can also be 
found in accessory great saphenous veins (i.e., Anterior Accessory Great Saphenous Vein [AAGSV] or 
Posterior Accessory Great Saphenous Vein [PAGSV]) which parallel the GSV in the saphenous compartment, 
the SSV, or perforating veins. The perforator veins drain from the superficial veins toward the deep 
(intramuscular) veins.  Pathologic perforator veins are defined by outward flow duration >500 ms, vein 
diameter >3.5 mm and located underneath skin damage or ulceration.7 Variations in the anatomy of the deep 
and superficial venous systems are common. 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.