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Issue Number - Name
0145-Endovenous Radiofrequency Ablation (ERFA) and Endovenous Laser Treatment (EVLT) for Lower Extremity Varicose Veins
Review Type
Complex
Claim Type
Ambulatory Surgical Center, Outpatient Hospital, Professional Services
Region and State
First Coast, NGS, Novitas, Palmetto, WPS, CGS, Noridian
Date Approved
02/05/2019

Description

Claims for ERFA and EVLT for Lower Extremity Varicose Veins are not deemed to be medically necessary will be denied based on the guidelines outlined in the respective MAC's LCDs

Affected Codes

36475- Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency, first vein treated

36476- 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- Second and subsequent veins treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)

76937- Ultrasonic guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting

Applicable Policy References

Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)-Exclusions from Coverage and Medicare as a Secondary Payer
Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1833(e)-Payment of Benefits
42 CFR Section 405.980-Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)-Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)-Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
42 CFR Section 405.986-Good Cause for Reopening
CGS LCD, L34082-Varicose Veins of the Lower Extremity, Treatment of, Effective 10/1/2015, Revised 1/1/2018
First Coast LCD, L33762-Treatment of Varicose Veins of the Lower Extremity, Effective 10/1/2015, Revised 7/10/2018
NGS LCD, L33575-Varicose Veins of the Lower Extremity, Treatment of, Effective 10/1/2015, Revised 1/1/2018
Noridian LCD, L34209-Treatment of Varicose Veins of the Lower Extremities, Effective 10/1/2015, Revised 1/1/2018
Noridian LCD, L34010-Treatment of Varicose Veins of the Lower Extremities, Effective 10/1/2015, Revised 1/1/2018
Novitas LCD, L34924-Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities, Effective 10/1/2015, Revised 5/17/2018
Palmetto LCD, L33454-Varicose Veins of the Lower Extremities, Effective 10/1/2015, Revised 11/12/2018
WPS LCD, L34536-Treatment of Varicose Veins of the Lower Extremities, Effective 10/1/2015, Revised 7/1/2018
First Coast LCA, A55963-Treatment of Varicose Veins of the Lower Extremity-revision to the Part A/B LCD, Effective 4/17/2018
First Coast LCA A56064-Treatment of Varicose Veins of the Lower Extremity-revision to the Part A/B LCD, Effective 7/10/2018
NGS LCA, A52870-Varicose Veins of the Lower Extremity, Treatment of- Supplemental Instructions Article, Effective 10/1/2015; Revised 1/1/2018
Novitas, A55229-Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities, Effective 8/11/2016; Revised 5/17/2018