CPT 93970, in plain terms, covers Complete duplex ultrasound of the veins of both arms or both legs. CPT 93970 is referenced in 5 tracked payer policy changes from Medicare/CMS - LCD, Regence BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 93970 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 93970 on AAPC
CGS's LCD L34045 (Non-Invasive Vascular Studies), revised with an effective date of 11/5/2026, expands coverage to include arterial fibromuscular dysplasia (FMD) for non-invasive vascular studies, based on new literature and societal input supporting non-invasive testing for this condition. The revision is described as a coverage expansion rather than a restriction, with all other existing indications and limitations carried over from the prior version.
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.
This is a NEW varicose vein treatment prior authorization policy effective October 1, 2026, establishing strict medical necessity criteria for coverage. Treatment now requires documented functional impairment with 3+ months of conservative therapy, specific vein measurements from imaging studies, and incompetence exceeding 0.5 seconds. Multiple ablation and sclerotherapy techniques are classified as investigational. Several procedures previously may have been covered without these requirements.
Aetna Clinical Policy Bulletin 0179 covers viscosupplement (hyaluronate) injections for knee osteoarthritis under commercial medical plans, and considers all other indications experimental, investigational, or unproven. Initial approval requires radiographic evidence of knee osteoarthritis or at least five listed signs and symptoms, knee pain that interferes with functional activities, an inadequate response or adverse effects with non-pharmacologic treatment, an inadequate response, intolerance or contraindication to an analgesic trial for at least 3 months, an inadequate response, intolerance or contraindication to intra-articular steroid injections for at least 3 months, and no total knee replacement scheduled within 6 months of starting treatment. Continuation requires improvement in pain and functional capacity after prior injections and at least 6 months since the last injection in the prior completed series. the policy was last reviewed 09/02/2026, and its next review is listed for 01/28/2027.
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.
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