Harvard Pilgrim is updating our medical review criteria for varicose vein procedures to include coverage for three additional codes for microfoam sclerotherapy and endomechanical ablation, which are medically necessary for certain indications.
With prior authorization, Harvard Pilgrim covers specific non-experimental procedures that are reasonable and medically necessary for the treatment of symptomatic refluxing varicose veins of the lower extremity. Effective for dates of service beginning July 1, 2017, Harvard Pilgrim will also provide reimbursement for the following three CPT codes, when all necessary criteria have been met:
- 36473 — Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated.
- 36474 — Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure).
- 37799 — Unlisted procedure, vascular surgery (used for less than 10 stabs incisions see 37765)
For more information, please refer to Harvard Pilgrim’s updated Varicose Vein Procedures Medical Review Criteria.