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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 state that 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). 
 
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.
 
Variations in the anatomy of the deep and 
superficial venous systems are common. 
 
Invasive Procedures for the management of chronic venous insufficiency: 
- Sclerotherapy: 
 
Sclerotherapy is a treatment of the veins using liquid sclerosant agents or sclerosing foam. Sclerosing 
agents are a chemical agent that causes endothelial damage leading to sclerosis of the venous segment 
once it is injected into the vein lumen. Sclerosing foam is made from a sclerosant agent and a gas. 
 
 
o Foam Sclerosant: Ultrasound-Guided Foam Sclerotherapy (UGFS): 
 
Foam sclerotherapy is a procedure that is performed under ultrasound guidance. There are 
different types of foam: physician-compounded foam (PCF) and non-compounded foam 
(NCF). The target, non-target, perforating, and adjacent deep veins are evaluated by ultrasound. 
UGFS is used for treatment of primary and recurrent varicose veins, including the distal GSV 
and SSV, perforating veins, and venous malformations. 
o Liquid Sclerosant: 
 
Liquid sclerotherapy is often used to treat cosmetic telangiectasias and reticular veins. Liquid 
sclerotherapy is also of value in addressing bleeding telangiectasia and for select cases of large 
vein treatment where unique patient features suggest liquid may be a safer option. 
 
Some examples (not all inclusive) of agents for sclerotherapy include sodium tetradecyl sulfate 
(STS), polidocanol, sodium morrhuate, and glycerin, which is typically used with epinephrine. 
You can find this rule at the Medicare Local Coverage Determination (LCD) L38720: Treatment of Chronic 
Venous Insufficiency of the Lower Extremities. 

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.