Treatment of Varicose Veins of the Lower Extremities (L30143)
Contractor Information
|
Contractor Name Wisconsin Physicians Service Insurance Corporation |
Contractor Number 00951, 00952, 00953, 00954, 52280, 05101, 05201, 05301, 05401, 05102, 05202, 05302, 05402 |
Contractor Type Carrier - FI - MAC |
LCD Information
Document Information
L30143 LCD Title Treatment of Varicose Veins of the Lower Extremities Contractor's Determination Number GSURG-041 AMA CPT/ADA CDT Copyright Statement CPT codes, descriptions and other data only are copyright 2010 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. |
Primary Geographic Jurisdiction
Oversight Region Original Determination Effective Date For services performed on or after 11/15/2009 Original Determination Ending Date Revision Effective Date For services performed on or after 03/01/2012 Revision Ending Date |
CMS National Coverage Policy
Title XVIII of the Social Security Act section 1862(a) (1) (A). This section excludes coverage and payment for items and services that are not considered reasonable and necessary for the diagnosis and treatment of illness or injury or to improve the function of a malformed body member.
Indications and Limitations of Coverage and/or Medical Necessity
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 supports the use of ultrasound guidance during the procedure and shows that the outcomes may be improved and complication rates may be minimized when ultrasound guidance is used. The CPT codes for radiofrequency and laser include the intra-operative ultrasound service in the valuation 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 (CPT codes: 37700, 37718, 37722, 37735, 37760, 37761 37765, 37766, 37780, 37785) and sclerotherapy (CPT codes: 36470, 36471):
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 (36468) will be considered medically necessary only if there is associated hemorrhage (IDC-9 459.0)
B. Indications for ERFA or laser ablation (CPT codes 36475, 36476, 36478, 36479):
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.
C. Limitations for ERFA and laser ablation:
1. ERFA and laser ablation are covered only for the treatment of symptomatic varicosities of the lesser or greater saphenous veins and their tributaries which have failed 3 months of conservative therapy.
2. Intra-operative ultrasound guidance is not separately payable with ERFA, laser ablation.
3. The treatment of asymptomatic varicose veins, or symptomatic varicose veins without a 3-month trial of conservative measures, by any technique, will be considered cosmetic and therefore not covered.
4. The treatment of spider veins or superficial telangiectasis by any technique is also considered cosmetic, and therefore not covered unless there is associated bleeding.
5. Coverage is only for devices specifically FDA-approved for these procedures.
6. One pre-operative Doppler ultrasound study or duplex scan will be covered.
7. Post –procedure Doppler ultrasound studies will be allowed if medically necessary.
The stab phlebectomy of the same vein performed on the same day as endovenous radiofrequency or laser ablation may be covered if the criteria for reasonable and necessary as described in this LCD are met.
If sclerotherapy is used with endovenous ablation, it may be covered if the criteria for reasonable and necessary as described in this LCD are met.
The treatment of asymptomatic veins with endoluminal ablation or sclerotherapy is not considered medically reasonable and necessary. If it is determined on review that the varicose veins were asymptomatic, the claim will be denied as a noncovered (cosmetic) procedure.
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 supports the use of ultrasound guidance during the procedure and shows that the outcomes may be improved and complication rates may be minimized when ultrasound guidance is used. The CPT codes for radiofrequency and laser include the intra-operative ultrasound service in the valuation 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 (CPT codes: 37700, 37718, 37722, 37735, 37760, 37761 37765, 37766, 37780, 37785) and sclerotherapy (CPT codes: 36470, 36471):
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 (36468) will be considered medically necessary only if there is associated hemorrhage (IDC-9 459.0)
B. Indications for ERFA or laser ablation (CPT codes 36475, 36476, 36478, 36479):
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.
C. Limitations for ERFA and laser ablation:
1. ERFA and laser ablation are covered only for the treatment of symptomatic varicosities of the lesser or greater saphenous veins and their tributaries which have failed 3 months of conservative therapy.
2. Intra-operative ultrasound guidance is not separately payable with ERFA, laser ablation.
3. The treatment of asymptomatic varicose veins, or symptomatic varicose veins without a 3-month trial of conservative measures, by any technique, will be considered cosmetic and therefore not covered.
4. The treatment of spider veins or superficial telangiectasis by any technique is also considered cosmetic, and therefore not covered unless there is associated bleeding.
5. Coverage is only for devices specifically FDA-approved for these procedures.
6. One pre-operative Doppler ultrasound study or duplex scan will be covered.
7. Post –procedure Doppler ultrasound studies will be allowed if medically necessary.
The stab phlebectomy of the same vein performed on the same day as endovenous radiofrequency or laser ablation may be covered if the criteria for reasonable and necessary as described in this LCD are met.
If sclerotherapy is used with endovenous ablation, it may be covered if the criteria for reasonable and necessary as described in this LCD are met.
The treatment of asymptomatic veins with endoluminal ablation or sclerotherapy is not considered medically reasonable and necessary. If it is determined on review that the varicose veins were asymptomatic, the claim will be denied as a noncovered (cosmetic) procedure.
Coding Information
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
| 011x | Hospital Inpatient (Including Medicare Part A) |
| 012x | Hospital Inpatient (Medicare Part B only) |
| 013x | Hospital Outpatient |
| 071x | Clinic - Rural Health |
| 073x | Clinic - Freestanding |
| 085x | Critical Access Hospital |
Revenue Codes:
Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.
CPT/HCPCS Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.
| 0330 | Radiology - Therapeutic and/or Chemotherapy Administration - General Classification |
| 0360 | Operating Room Services - General Classification |
| 0490 | Ambulatory Surgical Care - General Classification |
| 0510 | Clinic - General Classification |
| 0520 | Free-Standing Clinic - General Classification |
| 36468 | SINGLE OR MULTIPLE INJECTIONS OF SCLEROSING SOLUTIONS, SPIDER VEINS (TELANGIECTASIA); LIMB OR TRUNK |
| 36470 | INJECTION OF SCLEROSING SOLUTION; SINGLE VEIN |
| 36471 | INJECTION OF SCLEROSING SOLUTION; MULTIPLE VEINS, SAME LEG |
| 36475 | ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN TREATED |
| 36476 | ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; SECOND AND SUBSEQUENT VEINS TREATED IN A SINGLE EXTREMITY, EACH THROUGH SEPARATE ACCESS SITES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 36478 | ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, LASER; FIRST VEIN TREATED |
| 36479 | ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, LASER; SECOND AND SUBSEQUENT VEINS TREATED IN A SINGLE EXTREMITY, EACH THROUGH SEPARATE ACCESS SITES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 37500 | VASCULAR ENDOSCOPY, SURGICAL, WITH LIGATION OF PERFORATOR VEINS, SUBFASCIAL (SEPS) |
| 37700 | LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS |
| 37718 | LIGATION, DIVISION, AND STRIPPING, SHORT SAPHENOUS VEIN |
| 37722 | LIGATION, DIVISION, AND STRIPPING, LONG (GREATER) SAPHENOUS VEINS FROM SAPHENOFEMORAL JUNCTION TO KNEE OR BELOW |
| 37735 | LIGATION AND DIVISION AND COMPLETE STRIPPING OF LONG OR SHORT SAPHENOUS VEINS WITH RADICAL EXCISION OF ULCER AND SKIN GRAFT AND/OR INTERRUPTION OF COMMUNICATING VEINS OF LOWER LEG, WITH EXCISION OF DEEP FASCIA |
| 37760 | LIGATION OF PERFORATOR VEINS, SUBFASCIAL, RADICAL (LINTON TYPE), INCLUDING SKIN GRAFT, WHEN PERFORMED, OPEN,1 LEG |
| 37761 | LIGATION OF PERFORATOR VEIN(S), SUBFASCIAL, OPEN, INCLUDING ULTRASOUND GUIDANCE, WHEN PERFORMED, 1 LEG |
| 37765 | STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; 10-20 STAB INCISIONS |
| 37766 | STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; MORE THAN 20 INCISIONS |
| 37780 | LIGATION AND DIVISION OF SHORT SAPHENOUS VEIN AT SAPHENOPOPLITEAL JUNCTION (SEPARATE PROCEDURE) |
| 37785 | LIGATION, DIVISION, AND/OR EXCISION OF VARICOSE VEIN CLUSTER(S), 1 LEG |
| 37799 | UNLISTED PROCEDURE, VASCULAR SURGERY |
| 93965 | NONINVASIVE PHYSIOLOGIC STUDIES OF EXTREMITY VEINS, COMPLETE BILATERAL STUDY (EG, DOPPLER WAVEFORM ANALYSIS WITH RESPONSES TO COMPRESSION AND OTHER MANEUVERS, PHLEBORHEOGRAPHY, IMPEDANCE PLETHYSMOGRAPHY) |
| 93970 | DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; COMPLETE BILATERAL STUDY |
| 93971 | DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; UNILATERAL OR LIMITED STUDY |
ICD-9 Codes that Support Medical Necessity
ICD-9 Codes that Support Medical Necessity
Note: ICD-9 codes must be coded to the highest level of specificity.
These are the only ICD-9-CM codes that support medical necessity for the following CPT codes: 36470, 36471, 36475, 36476, 36478, 36479, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780 and 37785.
For CPT code: 36468,
Note: ICD-9 codes must be coded to the highest level of specificity.
These are the only ICD-9-CM codes that support medical necessity for the following CPT codes: 36470, 36471, 36475, 36476, 36478, 36479, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780 and 37785.
| 451.0 | PHLEBITIS AND THROMBOPHLEBITIS OF SUPERFICIAL VESSELS OF LOWER EXTREMITIES |
| 451.2 | PHLEBITIS AND THROMBOPHLEBITIS OF LOWER EXTREMITIES UNSPECIFIED |
| 454.0 - 454.8 | VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER - VARICOSE VEINS OF LOWER EXTREMITIES WITH OTHER COMPLICATIONS |
| 459.11 - 459.19 | POSTPHLEBETIC SYNDROME WITH ULCER - POSTPHLEBETIC SYNDROME WITH OTHER COMPLICATION |
| 459.31 | CHRONIC VENOUS HYPERTENSION WITH ULCER |
| 459.32 | CHRONIC VENOUS HYPERTENSION WITH INFLAMMATION |
| 459.33 | CHRONIC VENOUS HYPERTENSION WITH ULCER AND INFLAMMATION |
For CPT code: 36468,
| 448.9 | OTHER AND UNSPECIFIED CAPILLARY DISEASES |
| 459.0 | HEMORRHAGE UNSPECIFIED |
Diagnoses that Support Medical Necessity
ICD-9 Codes that DO NOT Support Medical Necessity
| V50.1 | OTHER PLASTIC SURGERY FOR UNACCEPTABLE COSMETIC APPEARANCE |
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
General Information
1. Each claim must be submitted with an ICD-9-CM code(s) that reflects the condition of the patient and indicates the reason(s) for which the service was performed.
2. The patient's medical record must contain a history and physical examination supporting the diagnosis of symptomatic varicose veins, and the failure of an adequate (at least 3 months) trial of conservative management.
3. The medical record must document the performance of appropriate tests, if medically necessary, to confirm the pathology of the vascular anatomy.
4. This documentation must be made available to Medicare upon request.
5. The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This policy does not take precedence over CCI edits. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.
6. When the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary under Section 1862(a)(1) of the Social Security Act.
7. When requesting a written redetermination (formerly appeal), providers must include all relevant documentation with the request.
2. The patient's medical record must contain a history and physical examination supporting the diagnosis of symptomatic varicose veins, and the failure of an adequate (at least 3 months) trial of conservative management.
3. The medical record must document the performance of appropriate tests, if medically necessary, to confirm the pathology of the vascular anatomy.
4. This documentation must be made available to Medicare upon request.
5. The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This policy does not take precedence over CCI edits. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.
6. When the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary under Section 1862(a)(1) of the Social Security Act.
7. When requesting a written redetermination (formerly appeal), providers must include all relevant documentation with the request.
Appendices
Utilization Guidelines
Sources of Information and Basis for Decision
1. Other carrier policies
2. Contractor Advisory Committee Members
3. Chandler JG, Pichot O, Sessa C, et al. Treatment of primary venous insufficiency by endovenous saphenous vein obliteration. Vasc Surg 2000; 34:201-14
4. Fassiadis N, Kianifard B, Holdstock JM, Whiteley MS. A novel approach to the treatment of recurrent varicose veins. Int Angiol, 2002 Sep; 21(3): 275-6. Abstract. PubMed
5. Forrestal, MD, Min, RJ, et. al. Endovenous Laser Treatment (EVLT) for Varicose Veins-A review. Today's Therapeutic Trends, 299-310. Communications Media for Education, Inc., Princeton, New Jersey.
6. Goldman M. Closure of the greater saphenous vein with endoluminal radiofrequency thermal heating of the vein wall in combination with ambulatory phlebectomy: preliminary 6 month follow-up. Dermatologic Surg 2000; 26:452-56
7. Jones L, Braithwaite BD, Selwyn D et al. Neovascularization is the principal cause of varicose vein recurrent: Results of a randomized trial of stripping the long saphenous vein. Euro J Vasc Endovasc Surg 1996; 12:442-45
8. Lurie F, Creton D, Eklof B et al. Prospective randomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation and stripping in a selected patient population. J Vasc Surg 2003; 38:207-14
9. Manufacturer's Literature. VNUS Medical Technologies, Inc.
10. Merchant RF, DePalma RG, Kabnick LS. Endovascular obliteration of saphenous reflux: a multicenter study. J Vasc Surg 2002; 35(6): 1190-6.
11. Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux. Long term results J Vasc Interv Radiol 2003;14:991-96.
12. Raju,S, and Neglen,P. Chronic venous insufficiency and varicose veins. N Engl Med 2009;360:2319-27.
13. Rautio T, Ohinmaa A, Perala J, Ohtonen P, Heikkinen T, Wiik H, Karjalainen P, Haukipuro K, Juvonen T. Endovenous versus conventional stripping operation in the treatment of primary varicose veins: a randomized controlled trial with comparison of the costs. J Vasc Surg 2002 May; 35(5): 958-965.
14. Sybrandy JE, Wittens, CH. Initial experiences in endovenous treatment of saphenous vein reflux. J Vasc Surg. 2002 Dec; 36(6): 1207-12. 10.
15. Weiss, R. MD. Varicose veins treated with radiofrequency ablation therapy. www.emedicine.com/derm/topic751.htm. Accessed February 26, 2009.
16. Winifred S. Hayes Technology Assessment - Endoluminal radiofrequency ablation for varicose veins of the leg. Winifred S. Hayes, Inc. June 2002.
2. Contractor Advisory Committee Members
3. Chandler JG, Pichot O, Sessa C, et al. Treatment of primary venous insufficiency by endovenous saphenous vein obliteration. Vasc Surg 2000; 34:201-14
4. Fassiadis N, Kianifard B, Holdstock JM, Whiteley MS. A novel approach to the treatment of recurrent varicose veins. Int Angiol, 2002 Sep; 21(3): 275-6. Abstract. PubMed
5. Forrestal, MD, Min, RJ, et. al. Endovenous Laser Treatment (EVLT) for Varicose Veins-A review. Today's Therapeutic Trends, 299-310. Communications Media for Education, Inc., Princeton, New Jersey.
6. Goldman M. Closure of the greater saphenous vein with endoluminal radiofrequency thermal heating of the vein wall in combination with ambulatory phlebectomy: preliminary 6 month follow-up. Dermatologic Surg 2000; 26:452-56
7. Jones L, Braithwaite BD, Selwyn D et al. Neovascularization is the principal cause of varicose vein recurrent: Results of a randomized trial of stripping the long saphenous vein. Euro J Vasc Endovasc Surg 1996; 12:442-45
8. Lurie F, Creton D, Eklof B et al. Prospective randomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation and stripping in a selected patient population. J Vasc Surg 2003; 38:207-14
9. Manufacturer's Literature. VNUS Medical Technologies, Inc.
10. Merchant RF, DePalma RG, Kabnick LS. Endovascular obliteration of saphenous reflux: a multicenter study. J Vasc Surg 2002; 35(6): 1190-6.
11. Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux. Long term results J Vasc Interv Radiol 2003;14:991-96.
12. Raju,S, and Neglen,P. Chronic venous insufficiency and varicose veins. N Engl Med 2009;360:2319-27.
13. Rautio T, Ohinmaa A, Perala J, Ohtonen P, Heikkinen T, Wiik H, Karjalainen P, Haukipuro K, Juvonen T. Endovenous versus conventional stripping operation in the treatment of primary varicose veins: a randomized controlled trial with comparison of the costs. J Vasc Surg 2002 May; 35(5): 958-965.
14. Sybrandy JE, Wittens, CH. Initial experiences in endovenous treatment of saphenous vein reflux. J Vasc Surg. 2002 Dec; 36(6): 1207-12. 10.
15. Weiss, R. MD. Varicose veins treated with radiofrequency ablation therapy. www.emedicine.com/derm/topic751.htm. Accessed February 26, 2009.
16. Winifred S. Hayes Technology Assessment - Endoluminal radiofrequency ablation for varicose veins of the leg. Winifred S. Hayes, Inc. June 2002.
Advisory Committee Meeting Notes
Meeting Date:
Wisconsin 05/15/2009
Illinois 05/13/2009
Michigan 05/06/2009
Minnesota 05/21/2009
J5 MAC 06/04/2009
Open Meeting 4/15/2009
Wisconsin 05/15/2009
Illinois 05/13/2009
Michigan 05/06/2009
Minnesota 05/21/2009
J5 MAC 06/04/2009
Open Meeting 4/15/2009
Start Date of Comment Period
06/04/2009
End Date of Comment Period
07/20/2009
Start Date of Notice Period
10/01/2009
Revision History Number
X
Revision History Explanation
01/01/2010 CPT annual update added code 37761, description change code 37760
Removed contractor number 05392 E MO. This number is being joined with W MO to include all of MO under one contractor number effective 8/01/2009.
04/03/2009 Approved
04/02/2009 Added CAC meeting dates AB
04/02/2009 Added as new draft LCD AB
11/15/2009 - The description for CPT/HCPCS code 37760 was changed in group 1
11/15/2009 - The description for CPT/HCPCS code 37765 was changed in group 1
11/15/2009 - The description for CPT/HCPCS code 37766 was changed in group 1
11/15/2009 - The description for CPT/HCPCS code 37785 was changed in group 1
3/7/2010 - The description for Bill Type Code 73 was changed
04/19/2010In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of American Somoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands were removed from this LCD because claims processing for those states are transitioning from FI Contractor Wisconsin Physician Services (WPS - 52280) to MAC Part A Contractor Palmetto.
8/1/2010 - The description for Bill Type Code 11 was changed
8/1/2010 - The description for Bill Type Code 12 was changed
8/1/2010 - The description for Bill Type Code 13 was changed
8/1/2010 - The description for Bill Type Code 71 was changed
8/1/2010 - The description for Bill Type Code 73 was changed
8/1/2010 - The description for Bill Type Code 85 was changed
8/1/2010 - The description for Revenue code 0330 was changed
8/1/2010 - The description for Revenue code 0360 was changed
8/1/2010 - The description for Revenue code 0490 was changed
8/1/2010 - The description for Revenue code 0510 was changed
8/1/2010 - The description for Revenue code 0520 was changed
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for those states are transitioning from FI Wisconsin Physicians Service (52280) to MAC Part A Trailblazer (04901).
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
36468 descriptor was changed in Group 1
36475 descriptor was changed in Group 1
36476 descriptor was changed in Group 1
36478 descriptor was changed in Group 1
37765 descriptor was changed in Group 1
01/14/2011 annual review no change in coverage.
02/21/2011 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
03/01/2012 annual review no change in coverage.
Removed contractor number 05392 E MO. This number is being joined with W MO to include all of MO under one contractor number effective 8/01/2009.
04/03/2009 Approved
04/02/2009 Added CAC meeting dates AB
04/02/2009 Added as new draft LCD AB
11/15/2009 - The description for CPT/HCPCS code 37760 was changed in group 1
11/15/2009 - The description for CPT/HCPCS code 37765 was changed in group 1
11/15/2009 - The description for CPT/HCPCS code 37766 was changed in group 1
11/15/2009 - The description for CPT/HCPCS code 37785 was changed in group 1
3/7/2010 - The description for Bill Type Code 73 was changed
04/19/2010In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of American Somoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands were removed from this LCD because claims processing for those states are transitioning from FI Contractor Wisconsin Physician Services (WPS - 52280) to MAC Part A Contractor Palmetto.
8/1/2010 - The description for Bill Type Code 11 was changed
8/1/2010 - The description for Bill Type Code 12 was changed
8/1/2010 - The description for Bill Type Code 13 was changed
8/1/2010 - The description for Bill Type Code 71 was changed
8/1/2010 - The description for Bill Type Code 73 was changed
8/1/2010 - The description for Bill Type Code 85 was changed
8/1/2010 - The description for Revenue code 0330 was changed
8/1/2010 - The description for Revenue code 0360 was changed
8/1/2010 - The description for Revenue code 0490 was changed
8/1/2010 - The description for Revenue code 0510 was changed
8/1/2010 - The description for Revenue code 0520 was changed
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for those states are transitioning from FI Wisconsin Physicians Service (52280) to MAC Part A Trailblazer (04901).
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
36468 descriptor was changed in Group 1
36475 descriptor was changed in Group 1
36476 descriptor was changed in Group 1
36478 descriptor was changed in Group 1
37765 descriptor was changed in Group 1
01/14/2011 annual review no change in coverage.
02/21/2011 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
03/01/2012 annual review no change in coverage.
Reason for Change
Maintenance (annual review with new changes, formatting, etc.)
Related Documents
This LCD has no Related Documents.
LCD Attachments
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Page Last Updated: Thursday, 01-Mar-2012 12:07:29 CST
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