Advocacy Alert: Medicare administrators First Coast and Novitas finalize coverage policies for varicose veins and venous stenting

Two of the country’s Medicare Administrative Contractors, who combined administer Medicare for about a third of the nation, have finalized their Local Coverage Determination (LCD) policies for varicose veins and endovenous stenting, effective 12/27/20. Before these LCDs go into effect in late December, AVLS members in the impacted states should review these policies at the links below to ensure they understand the LCD requirements. Of special note, the future LCDs define the Plan of Care as a 90 day period. Members should also carefully review the Future Coding and billing guidance that accompanies the varicose vein LCD and documentation requirements.

Review Future Coding & Billing Guidance

“Overall, our Advocacy Committee feels that both of these LCDs are a balanced and evidence-based approach to the clinical topics,” noted AVLS President Mark H. Meissner, MD, FAVLS. “For varicose veins, the LCD mandates a required plan of care that offers the option of prompt interventional treatment for patients who need care, as well as a 2-4 week conservative management period for those patients who might benefit from only conservative care,” added Dr. Meissner.

The future vein LCDs allow physicians to use all of the varicose vein treatment modalities that have current Category I CPT codes per the documented plan of care. Cosmetic vein care, i.e., CPT code 36468, remains not reimbursable as per conventional language across the country with all payers.

For the future Endovenous stenting policies, the LCD enumerates 13 covered indications where venous stenting is covered and allowable and lists eight limitations to coverage.

“Several AVLS members played a critical role in offering their clinical comments as these LCDs were under consideration, and in drafting our Societal comment letters to the carriers. A big Thank You to all of those involved in this effort, which goes back to the first steps taken in 2018,” added Dr. Meissner.

Links to Future LCDs:

First Coast Varicose Veins Future Effective policy: 12/27/20

First Coast Endovenous Stenting Future Effective Policy: 12/27/20

Novitas Solutions Varicose Veins Effective Policy: 12/27/20

Novitas Solutions Endovenous Stenting Future Effective Policy: 12/27/20