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Varicose Vein Treatment
Act
by Sep 15, 2026
Effective date
Oct 1, 2026
Identified
Jul 7, 2026
Summary
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.
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What to do
by Sep 15, 2026 · 9 steps
01Billing team must implement prior authorization requirements for all varicose vein treatment requests in the billing system.
02Providers must document: (1) one of five medical indications (functional impairment, thrombophlebitis, hemorrhage, CEAP C4, or ulceration), (2) venous imaging study results with specific vein diameters and reflux measurements in seconds, and (3) for functional impairment cases—three consecutive months of conservative therapy with graded compression stockings (15-20 mmHg) and two clinical supervision visits.
03Update encounter forms and provider education materials to require this documentation before submission.
04Flag claims for CPT 93970/93971 as requiring prior authorization.
05Deny or recoup payments for: endovenous ablation of accessory saphenous veins, branch tributaries, perforator veins, cryoablation, mechanochemical ablation, microwave ablation, and steam injection ablation (classified as investigational).
06Deny sclerotherapy of vulvar varices.
07Deny routine follow-up imaging within 6 months post-treatment.
08Claims lacking required documentation or not meeting Criterion I will be denied.
09Train front desk and billing staff on the October 1, 2026 effective date to prevent premature denials.
Codes mentioned
9397093971
Original notice
Varicose Vein Treatment
beonbrand.getbynder.com · Always check the source before changing claims.