CPT 37799 is referenced in 16 tracked payer policy changes from Sentara Health Plans, Health Net, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 37799 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
Health Net is updating prior authorization requirements effective April 1, 2026, adding PA requirements for multiple procedures including reconstructive surgery, cardiac procedures, neurostimulators, and EEGs while removing PA requirements for pediatric surgeries, wound care, and certain DME items. These changes affect Commercial, Medi-Cal, and Medicare plans with the goal of reducing administrative burden.
Independence Blue Cross Medicare Advantage updated policy MA11.001l effective 01/01/2026 to expand coverage of varicose vein treatments. Key changes include: CPT 36468 reclassified from cosmetic to medically necessary, CPT 36482 and 36483 upgraded from experimental/investigational to medically necessary, HCPCS S2202 (Echosclerotherapy) now covered, new CPT 37799 added for stab phlebectomy with fewer than 10 incisions, and CPT 37500 deleted. Additional coverage added for bulbous varicosities, venous malformations, and telangiectasia with hemorrhage.
Independence Blue Cross Medicare Advantage reissued policy MA11.001l effective 01/01/2026 with expanded coverage for varicose vein treatments. Key changes include: sclerotherapy and cyanoacrylate adhesive now covered for saphenous veins; CPT 36468 reclassified from cosmetic to medically necessary; CPT 36482 and 36483 upgraded from experimental/investigational to medically necessary; S2202 echosclerotherapy upgraded to medically necessary; CPT 37500 deleted; and CPT 37799 added for stab phlebectomy with fewer than 10 incisions.
Independence Blue Cross updated MA policy MA11.001k to MA11.001l effective 07/28/2025, clarifying TIPP terminology, revising the Venous Clinical Severity Score (VCSS) threshold for saphenous vein treatment from less than 6 to greater than 6, adding CPT 37799 for endovenous cryoablation, and removing experimental/investigational language for certain perforator vein procedures. These changes affect coverage criteria and billing for varicose vein treatments.
Endovenous laser ablation, radiofrequency ablation, polidocanol 1% microfoam (Varithena) and cyanoacrylate adhesive ablation (VenaSeal) are considered medically appropriate for symptomatic varicose veins or venous insufficiency when all of these are met: saphenous reflux of at least 500 milliseconds documented by duplex ultrasound, CEAP class C2 or greater, and a documented indication of ulceration from venous stasis, recurrent superficial thrombophlebitis, hemorrhage from a ruptured superficial varicosity, or persistent symptoms that significantly interfere with activities of daily living after compression therapy and activity modification for at least 3 months have not improved them. Phlebectomy, sclerotherapy and transilluminated powered phlebectomy (TPP/TIPP) are considered medically appropriate for symptomatic varicose tributaries when performed concurrently with or following prior treatment of the saphenous veins. Sclerotherapy and transcutaneous laser ablation of small diameter veins (spider veins or telangiectasia), and any treatment of asymptomatic varicose veins, are considered not medically necessary, while balloon catheter-assisted sclerotherapy, cryoablation, coil embolization, mechanochemical or endomechanical ablation (e.g., ClariVein), photothermal sclerosis (intense pulsed light), and sclerotherapy techniques other than microfoam for great, small or accessory saphenous veins are considered investigational.
Varicose vein treatment is medically necessary only when the policy criteria are met, and member contract language takes precedence for eligibility. Treatment requires one of five qualifying indications and a complete venous imaging study of the superficial veins that records vein diameter and reflux in seconds at multiple levels in the thigh and calf. The qualifying indications are functional impairment of instrumental activities of daily living after at least three months of medically supervised compression therapy, recurrent superficial thrombophlebitis documented by venous imaging, recurrent or persistent hemorrhage from a ruptured varix, CEAP C4 skin and subcutaneous changes, or ulceration from venous stasis where incompetent varices are a significant contributing factor. Endovenous radiofrequency, laser or glue ablation of the great or small saphenous veins requires a vein diameter of 5.5 mm or greater for the great saphenous vein or 4 mm or greater for the small saphenous vein, reflux exceeding 0.5 seconds, and treatment of all incompetent segments of the same vein in the same session with the same modality. Cryoablation, mechanochemical, microwave, steam and high-intensity focused ultrasound ablation of any vein are investigational, as is radiofrequency, glue or laser ablation of veins other than the great or small saphenous veins. Sclerotherapy of superficial veins less than 4 mm in diameter, including reticular veins and telangiectasias, is cosmetic.
Independence Blue Cross has reissued Policy 11.02.01v effective 01/01/2026 with CPT code updates for varicose vein treatment. CPT code 37500 has been deleted and replaced with NOC code 37799. The policy maintains coverage for saphenous vein treatments (surgery, endovenous ablation, sclerotherapy, cyanoacrylate adhesives) when medical necessity criteria are met, including documented symptoms and duplex ultrasound confirmation of venous incompetence.
Independence Blue Cross has reissued policy 11.02.01v with minor updates effective 01/01/2026, including deletion of CPT code 37500 and addition of NOC code 37799 as part of annual CPT code maintenance. The policy continues to cover varicose vein treatments (surgery, endovenous ablation, sclerotherapy, cyanoacrylate adhesives) for great/small saphenous veins and accessory saphenous veins when medical necessity criteria are met.
Aetna considers percutaneous embolization (by balloon or metallic coil) or ligation medically necessary for varicocele when any of these apply: adolescents with grade 2 or 3 varicoceles associated with ipsilateral testicular growth retardation, males with infertility problems who have decreased sperm motility and lower sperm concentrations, post-surgical (ligation) recurrence of varicoceles, or scrotal pain associated with varicoceles. Embolization or ligation for persons who do not meet these criteria is considered experimental, investigational, or unproven, and microsurgical varicocelectomy is considered an acceptable alternative when any of these criteria is met. Adding a sclerosant agent to coil embolization, endoluminal occlusion devices such as the ArtVentive system, endovenous laser ablation of the spermatic vein, surgical treatment for subclinical varicocele, and varicocelectomy for non-obstructive azoospermia are considered experimental, investigational, or unproven.
Aetna considers ligation, stripping, radiofrequency, endovenous laser and cyanoacrylate closure of the saphenous veins medically necessary when incompetence at the saphenofemoral or saphenopopliteal junction is documented by ultrasound performed within the past 6 months, with junctional reflux of 500 milliseconds or greater, a vein at least 4.5 mm in diameter below the junction, and the symptom criteria in the policy are met. Liquid or foam sclerotherapy (for example Varithena) is medically necessary for symptomatic saphenous veins, varicose tributaries, accessory veins and perforator veins that are 2.5 mm or greater in diameter when the criteria are met, and ambulatory phlebectomy is medically necessary as adjunctive treatment under the same size and symptom criteria. Treatment of veins less than 2.5 mm is considered cosmetic, endovenous ablation of varicose tributaries and accessory veins other than the accessory saphenous vein is considered experimental, investigational or unproven, and sclerotherapy for reflux at the saphenofemoral or saphenopopliteal junction is considered experimental.
Use of wireless pressure sensors is considered investigational in the intra-operative and/or post-operative management of patients having endovascular aneurysm repair. These implanted devices transmit pressure readings wirelessly to external devices, and the accuracy of these devices must be determined before their benefits and risks can be evaluated. The FDA cleared the CardioMEMS EndoSure system through the 510(k) process for measuring intrasac pressure during endovascular abdominal aortic aneurysm repair, and the ImPressure ultrasound-based system is in use in Europe and in an investigational device exemption trial of stent grafts.
Endovascular therapy for saccular intracranial aneurysms of the posterior cerebral circulation, and for other intracranial aneurysms whose surgical ligation and clipping would pose great technical difficulty or be medically contraindicated, is considered medically necessary. Endovascular therapy for intracranial aneurysms or pseudoaneurysms whose location and morphology would allow relatively simple surgical ligation and clipping is considered investigational. Definitive patient selection criteria for endovascular therapy for intracranial aneurysms and pseudoaneurysms have not been established.
Endovascular occlusion of the ovarian vein and internal iliac veins is considered investigational as a treatment of pelvic congestion syndrome. CPT codes 37241 and 37799 and ICD-10 procedure codes 06LH3DZ, 06LH3ZZ, 06LJ3DZ and 06LJ3ZZ are listed as investigational in the policy.
Blue Cross Blue Shield Association policy 7.01.124 (BCBSMS policy A.7.01.124) states that treatment of great or small saphenous veins, accessory saphenous veins, varicose tributaries, and perforator veins may be considered medically necessary for symptomatic varicose veins or venous insufficiency when specific criteria are met, and that saphenous vein treatment not meeting those criteria is considered cosmetic and investigational. The policy history shows an update dated 09/22/2026 that changed the policy description, made minor changes to the statements for great or small saphenous veins, accessory saphenous veins, and perforator veins, and re-worded the concurrent treatment statements for accessory saphenous veins and symptomatic varicose tributaries for clarity. Telangiectasia treatment is considered cosmetic and investigational.
Independence Blue Cross updated policy 11.02.01u to 11.02.01v, clarifying TIPP (Trivex System) language in treatment of varicose veins and adding CPT 37799 (Experimental/Investigational) to represent endovenous cryoablation. The policy intent remains unchanged; this is a technical clarification update effective July 28, 2025.
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