by AJ Riviezzo
United Healthcare (UHC) has put out a new policy effective July 1, 2024 (policy number 2024T0447NN). There are a few significant changes in the policy.
The first major change is vein size. UHC has joined Medicare and most other major commercial plans in requiring 3.0 mm or greater for the Great Saphenous Vein (as measured at the Saph-Fem Junction) and 3.0 mm for the Small Saphenous Vein as well as Accessory Veins as measured immediately below the appropriate junction. This is significantly different than the current 5.5 mm for GSV and 5.0 mm for SSV.
The requirements for treatment are essentially the same after that with the patient having skin ulceration, frank bleeding of the Varicose Vein, thrombophlebitis, stasis dermatitis or moderate to severe pain causing functional or physical impairment. Reflux still remains at 500 milliseconds for the GSV, SSV, or principal tributaries.
Perforators may still be treated, but the vein size criteria moves up to 3.5 mm or greater with 500 or more milliseconds of reflux and the perforating vein must lie beneath a healed or active venous stasis ulcer.
The second major change is allowing the use of Varithena. This change is a bit buried in the policy (see attached here). Page three shows a list of acceptable CPT Codes. Page five has the ‘sclerotherapy’ sections noting that CPT codes 36465, 36466, 36470 and 36471 are covered codes. Use of any/all sclerotherapy is limited to three sessions per leg within a year (365 days beginning with the first sclerotherapy date of service).
For example, if you bill 36471 on the left leg July 5th and perform a Varthena sclero a week later on the left distal GSV, you will only have one sclerotherapy session remaining until July 4th of the following year.
The policy is silent regarding whether or not Varithena is authorized to be a primary rather than a secondary procedure. Given the placement of the language regarding Varithena, we believe it is intended to be used as a secondary or adjunct procedure.
As always, the Varithena codes (36465 and 36466) can only be used when treating truncal veins. The AMA’s CPT code description and UHC’s description of the codes (middle of page 5) make this very clear.
Sadly, UHC still views VenaSeal (cyanoacrylate-based adhesive) and ClariVein (mechanochemical ablations) as unproven and not approved for reimbursement. Kudos to Dr. James Albert and others who have continually pushed UHC to adopt policies more in keeping with Medicare standards.