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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. 
Historically, varicose veins have been treated by conservative measures such as exercise, periodic leg 
elevation, weight loss, compressive therapy, and avoidance of prolonged immobility. When conservative 
measures are unsuccessful, and symptoms persist, the next step has been sclerotherapy or surgical ligation with 
or without stripping. Sclerotherapy involves the injection of a sclerosing solution into the varicose vein(s). 
More recently, endoluminal radiofrequency ablation (ERFA) and endoluminal laser ablation have been 
developed as alternatives to sclerotherapy and surgical intervention. These procedures are designed to damage 
the intimal wall of the vein resulting in fibrosis and subsequent ablation of the lumen of a segment of the 
vessel. Both procedures utilize specially designed catheters inserted through a small incision in the distal thigh 
and advanced, often under ultrasound guidance, nearly to the saphenofemoral junction. The catheter is then 
slowly withdrawn while controlled radiofrequency or laser energy is applied. This is followed by external 
compression of the treated segment. 
Doppler ultrasound or duplex studies are often used to map the anatomy of the venous system prior to the 
procedure. There is adequate evidence that pre-procedural ultrasound is helpful, and Medicare will cover one 
ultrasound or duplex scan prior to the procedure to determine the extent and configuration of the varicosities 
when it is medically necessary. 
Evidence and clinical experience support the use of ultrasound guidance during the procedure and show that 
the outcomes may be improved, and complication rates may be minimized when ultrasound guidance is used. 
The codes for radiofrequency and laser include the intra-operative ultrasound service in the evaluation, and 
ultrasound may not be billed separately with these procedures. 
A duplex ultrasound examination is considered medically necessary and will be allowed when performed 
within 1 week (preferably within 72 hours) of EFRA to check for any evidence of thrombus extension from the 
saphenofemoral junction into the deep system. 
A. Indications for surgical treatment and sclerotherapy:  1. A 3-month trial of conservative therapy such as exercise, periodic leg elevation, weight loss, 
compressive therapy, and avoidance of prolonged immobility where appropriate, has failed, 
AND 
2. The patient is symptomatic and has one, or more, of the following: 
a. Pain, aching, cramping, burning, itching and/or swelling during activity or after 
prolonged standing severe enough to impair mobility 
b. Recurrent episodes of superficial phlebitis 
c. Non-healing skin ulceration 
d. Bleeding from a varicosity 
e. Stasis dermatitis 
f. Refractory dependent edema 
3. The treatment of spider veins/telangiectasis will be considered medically necessary only if there 
is associated hemorrhage. 
B. Indications for ERFA or laser ablation: 
 
In addition to the above (see A), the patient's anatomy and clinical condition are amenable to the 
proposed treatment including ALL of the following:  
1. Absence of aneurysm in the target segment. 
2. Maximum vein diameter of 20 mm for ERFA or 30 mm for laser ablation. 
3. Absence of thrombosis or vein tortuosity, which would impair catheter advancement. 
4. The absence of significant peripheral arterial diseases. 
You can find this rule in the Local Coverage Determination (LCD): Treatment of Varicose Veins of the Lower 
Extremities (L34536). 
 
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.