by AJ Riviezzo


Medicare just released their proposed rules. While there is a lot of information to unpack in the documents, there are some notable elements that will impact the phlebology community. First and foremost is the change in reimbursement for some codes.


In an effort to bring costs in line with reality, both RF and Laser (codes 36475 and 36478 respectively) are being decreased. Medicare had the catheter price for RF set at $725 and is working to bring it more in line with today’s $550 price. For laser, the cost per kit was set at $519 which they are bringing down to $323.33.   This year’s decrease for RF is 4.32 percent and laser is 5.97 percent. The non-thermal technologies also had a reimbursement drop. Varithena is going down by 1.9 percent, ClariVein by 2.62 percent and VenaSeal is dropping 7.11%.


The most startling decrease is in phlebectomies. The 10-20 stab phlebectomy is dropping 31.49 percent and the 20+ stab phlebectomy is dropping 32.6 percent. These changes are significant for a set of codes that, per many of the physicians with whom I speak, were already too low for the time involved. Apparently very few physicians completed the almost 50-page questionnaire. Often these services are performed with an ablation and subject to the second surgery 50% reduction. With the National Average Reimbursement for the two codes now set at $457.26 and $534.85 this can represent a significant decrease in revenue.


Whether or not you personally perform a phlebectomy, I would encourage each of you to work with any of the Societies you belong to push back on this change. Who knows what Medicare will impact next.  Medicare is accepting comments until September 27th of this year.


Attached is a spreadsheet that details key codes for a phlebology practice. It compared the reimbursement of the proposed 2020 rates versus 2019 based on the National Average. Your actual reimbursement may be higher or lower than what is shown due to the Geographic Pricing for your area (GPCI).  2020v2019


Another change that is being considered will impact hospital-based outpatient practices and ASC’s. Medicare is considering adding a pre-authorization requirement for venous treatment for these settings. This is a dramatic change from the past. It should be interesting to see if they are able to accomplish this across the various Medicare Administrators given that none of them, as far as I know, have an existing pre-authorization department.

No comments yet.

Leave a Reply