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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 Medicare will consider invasive procedures (only with the techniques outlined in this local 
coverage determination (LCD) and under the conditions described) as reasonable and necessary when 
documentation in the medical record includes a history, physical examination, CEAP clinical classification, and 
a venous duplex scan documenting reflux (>500 msec). 
 
    Liquid sclerotherapy will be considered reasonable and necessary to treat telangiectasias, reticular veins, 
small varicose veins (3-6 mm), residual or recurrent veins following endovenous ablation or surgery, and 
perforator veins. Treatment of telangiectasias and reticular veins (C1) (Less than 3 mm) is considered 
reasonable and necessary with documentation of spontaneous and/or traumatic venous hemorrhage, OR for 
dilated intradermal veins in the elderly judged to be a substantial risk for hemorrhage with minimal 
trauma, OR near an active or healed ulcer if judged to contribute to local venous hypertension. 
    Saphenous veins (GSV, SSV, AAGSV) management, with UGFS, endovenous thermal ablation 
(radiofrequency or laser), chemical adhesive (cyanoacrylate embolization), MOCA, and surgery (surgical 
ligation and stripping) is considered reasonable and necessary with documentation in the medical record of 
CEAP class C2-C6 disease, reflux (Greater than 500 msec), and ANY of the following signs or symptoms: 
        ulceration secondary to venous stasis; 
        significant pain or significant edema associated with saphenous reflux that interferes with activities of 
daily living (ADLs); 
        bleeding associated with ruptured superficial varicosity; 
        recurrent episodes of superficial phlebitis; 
        stasis dermatitis; 
        refractory dependent edema 
    Incompetent perforator veins (IPVs) are the most common cause of recurrent varicose veins after treatment. 
Minimally invasive treatments have replaced traditional surgical treatments for IPVs. UGFS and endovenous 
thermal ablation with either radiofrequency or laser energy sources will be considered reasonable and 
necessary9 with the following conditions: 
        Demonstrated perforator reflux greater than 500 msec; AND 
        No saphenous reflux (greater, small, or accessory) and/or symptomatic varicose tributaries; AND 
        An active venous ulcer; AND 
        The IPV is at least 3.5 mm in diameter; AND 
        The perforator is in the vicinity of the ulcer. 
 
Non-Invasive Venous Studies Pre-operative venous studies are considered reasonable and necessary prior to varicose vein treatment when 
initially performed by an accredited vascular technician. The study will fully define the anatomy, size, and 
tortuosity of the great and lesser saphenous vein, superficial venous segments, and perforators and will 
determine the extent of venous valvular incompetence. Medicare will cover a pre-procedure duplex scan used 
in conjunction with other non-invasive physiologic testing to determine the extent and configuration of the 
varicosities. It is expected that these studies will be performed by the physician planning to provide the therapy 
or by a registered vascular technologist (RVT). Medicare will cover intraoperative ultrasonic guidance in 
situations when it is medically necessary. Also, Medicare includes payment for the ultrasound in the payment 
for ERFA and laser ablation procedures. Palmetto GBA will allow for post procedure studies within a 6-month 
period. 
 
Credentialing and Accreditation Standards 
 
A vascular diagnostic study may be performed by a physician, a certified technologist, or in a certified vascular 
testing lab. The accuracy of non-invasive vascular diagnostic studies depends on the knowledge, skill, and 
experience of the technologist and interpreter. Services will be considered reasonable and necessary only if 
performed by appropriately trained providers. All non-invasive vascular diagnostic studies must be performed 
meeting at least one of the following: 
 
    performed by a licensed qualified physician, OR 
    performed by a technician who is certified in vascular technology, OR 
    performed in facilities with laboratories accredited in vascular technology. 
 
You can find this information in Medicare's Local Coverage Determination (LCD): Treatment of Varicose 
Veins of the Lower Extremities (L39121). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.