| by AJ Riviezzo |
| The various Medicare administrators (MACs) have been allowing the non-thermal technologies (ClariVein, Varithena and VenaSeal) to be paid (First Coast Service Options covering Florida/Puerto Rico does not cover ClariVein unfortunately). However, the language in the various Local Coverage Determinations by most of the MACs has not been updated. This leads to some confusion as to what is and is not covered. In some of the MACs they merely updated the list of codes without changing the written section. Novitas, forever a source of confusion, came out with a proposed sclerotherapy policy in which they grouped the non-thermal technologies (NTTs). This proposed policy would have expressly not covered these procedures. This policy was put into abeyance and is not active. As such, Novitas currently pays for the NTTs.
Where it gets a bit more interesting is that the Medicare Advantage plans (Medicare replacement plans) are supposed to follow Medicare’s guidelines. As the various MACs were less than clear in their written sections, this has allowed an out clause for many of the Medicare Advantage plans to not cover the several NTTs. Despite being provided Medicare Explanations of Benefits they still turn a blind eye towards coverage. We strongly recommend double checking with any of the Medicare Advantage plans to ensure the technology you wish to use is covered. If they state no pre-authorization is required it is usually because they are not covering that service. I would ask for a voluntary pre-determination in that instance. |
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