First Coast and Novitas Finalize LCD Medicare Policies for Varicose Veins and Venous Stenting

November 17, 2020—The American Vein & Lymphatic Society (AVLS) announced that two Medicare Administrative Contractors, which administer Medicare for approximately a third of the United States, have finalized their Local Coverage Determination (LCD) policies for varicose veins and endovenous stenting, effective December 27, 2020. The policies are linked in the AVLS announcement.

The two contractors are Novitas (which administers to Colorado, New Mexico, Oklahoma, Texas, Arkansas, Louisiana, Mississippi, Delaware, the District of Columbia, Maryland, New Jersey, and Pennsylvania) and First Coast (which administers to Florida, Puerto Rico, and the United States Virgin Islands).

AVLS advised that the society’s members in the impacted states should review these policies to ensure they understand the LCD requirements before they go into effect. 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, stated AVLS.

AVLS noted the following policies:

• 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 (CPT code 36468) remains not reimbursable as per conventional language across the country with all payers.
• For future endovenous stenting policies, the LCD enumerates 13 covered indications where venous stenting is covered and allowable and lists eight limitations to coverage.

“Overall, our Advocacy Committee feels that both of these LCDs are a balanced and evidence-based approach to the clinical topics,” commented AVLS President Mark H. Meissner, MD, on the society’s announcement. “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- to 4-week conservative management period for those patients who might benefit from only conservative care.”

Dr. Meissner added, “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.”