Independence has reviewed the policy for endovenous mechanochemical ablation
(CPT® codes 36473, 36474) as part of the policy maintenance
process and procedure code review. Medical Policy #11.02.01p: Treatment of
Varicose Veins of the Lower Extremities and Perforator Vein Incompetence is
being updated to reflect that mechanochemical ablation will be considered
experimental/investigational for commercial members. This policy was posted as
a Notification on December 27, 2017, and will go into effect March 27, 2018.
Endovenous mechanochemical ablation is a minimally invasive treatment for
varicose veins, combining mechanical and chemical modalities. The procedure
involves the use of a special percutaneous infusion catheter, which contains a
rotating wire, providing endovenous mechanical destruction. Simultaneously, a
U.S. Food and Drug Administration-approved sclerosing agent (e.g., sodium
tetradecyl sulfate) is administered in order to enhance occlusion of the
vein.
Based on the available peer-reviewed literature and medical society
guidelines, these previously eligible services, identified by the following
procedure codes, which went into effect January 1, 2017, have been determined
to be experimental/investigational for our commercial HMO, POS, and PPO members
because the safety and/or effectiveness of these services cannot be established
by review of the available published peer-reviewed literature:
- CPT® 36473: Endovenous ablation therapy of
incompetent vein, extremity, inclusive of all imaging guidance and monitoring,
percutaneous, mechanochemical; first vein treated
- CPT® 36474: Endovenous ablation therapy of
incompetent vein, extremity, inclusive of all imaging guidance and monitoring,
percutaneous, mechanochemical; subsequent vein(s) treated in a single
extremity, each through separate access sites (List separately in addition to
code for primary procedure)
To view the Notification for this policy, visit our
Medical Policy Portal and select
Accept and Go to Medical
Policy Online. Then select
Commercial under Active Notifications.
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