Coverage of Conditions and Treatments (Coverage Decisions)
Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.
List also available in PDF format.
See Treatment Guidelines and Resources for additional information.
Varicose veins are a common manifestation of chronic venous insufficiency. Varicose veins often present only a cosmetic concern, but they can become clinically important. Several interventions are available to treat the condition.
Conditions of Coverage:
The following treatments for varicose veins are covered with conditions when indications/conditions are present:
- Endovenous Laser Ablation (EVLA)
- Radiofrequency Ablation (FRA)
Indications (required to be present):
- Demonstrated reflux in the affected vein AND
- Minimum of 3 months of symptoms of pain and/or swelling sufficient to interfere with instrumental ADLs, or presence of complications (e.g. ulceration, bleeding, recurrent thrombophlebitis).
- For tributary varicose veins, the above two conditions must apply and they must have a diameter ≥3 mm.
Exclusions: pregnancy, active infection, peripheral arterial disease, deep vein thrombosis (DVT).
Selected treatments for varicose veins were reviewed by the State Health Technology Clinical Committee (HTCC) in May 2017 and the determination was finalized on July 14, 2017. Complete information on this HTCC determination is available at: What we're working on | Washington State Health Care Authority
In adopting this HTCC coverage determination, the Department has concluded that the determination does not conflict with any state statute. Any coverage for investigational treatment would be considered per WAC 296-20-02850. Any coverage for health technologies that have a FDA Humanitarian Device Exemption status would be considered per RCW 70.14.120 (1) (b).
Implementation of the Coverage Decision
All requests for the treatments for varicose veins require prior authorization. The service may be covered only for care of a condition accepted on or related to the claim.
For billing information, please refer to L&I Fee Schedules and Payment Policies (MARFS).