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Coverage Indications  The Plan covers endovenous ablation (CPT 36475, 36476 – radio-frequency; 36478, 36479 – laser) and ultrasound-guided foam sclerotherapy (36465, 36466) for symptomatic lower-extremity CVI/varicose veins when all criteria A–D are met:    A. Clinical Presentation – limb aching, heaviness, edema, skin changes (pigmentation, lipodermatosclerosis) or healed/active venous ulcer documented for = 3 months.  B. Imaging – duplex scan within 6 months showing = 0.5 sec reflux in the great, small or accessory saphenous vein and vein diameter = 3.5 mm.  C. CEAP Class – C2 through C6.  D. Conservative Therapy – = 6 weeks of compression (20–30 mm Hg or higher), limb elevation and exercise, without adequate symptom relief.    Covered ICD-10-CM (examples, not exhaustive): I83.10–I83.129, I83.891-I83.899, I87.2.  Telangiectasia/spider veins (I78.1, L90.4, R22.0) are considered cosmetic and non-covered.    Utilization & Frequency Limits    One primary ablation (36475 or 36478) per saphenous vein, per limb, lifetime.    One adjunct second-order ablation (36476 or 36479) the same session if reflux extends into an accessory segment.    Foam sclerotherapy limited to 6 sessions per limb per calendar year.    Ambulatory/phlebectomy codes 37765, 37766 require prior ablation of the source reflux vein or documentation of isolated tributary incompetence.    Billing & Modifiers    Modifier 50 for bilateral procedures; payer processes at 150 % of fee schedule.    76942 (ultrasound guidance) is bundled with 36475-36479; separate payment will be denied.    If > 10 stab phlebectomy incisions are made, append Modifier 22 with op-note evidence.    Prior Authorization (PA)  PA is mandatory for 36475-36479, 36465-36466, 37765, 37766. Submit:    Office notes with symptoms & CEAP class    Duplex report with reflux measurements    Compression-therapy compliance dates    Planned codes & laterality    Limitations / Non-Covered Services    Cosmetic treatment of asymptomatic veins or telangiectasia    Repeat ablation of previously treated, patent-occluded veins    Isolated perforator ablation without prior failure of compression therapy    Investigational techniques (e.g., cyanoacrylate closure CPT 36482, mechanochemical ablation CPT 36473) unless FDA-approved and expressly listed in the Plan’s Technology Assessment Appendix.    Documentation Must Include    Photodocumentation of skin changes or ulcer (if C4–C6)    CEAP classification, Venous Clinical Severity Score (optional)    Duration and type of compression therapy used    Patient-reported symptom scale (e.g., CIVIQ-20) pre-treatment    Payment Determination  Claims not meeting all criteria will be denied Not Medically Necessary. Incomplete PA packets will be rejected Administrative Denial; resubmission permitted within 30 days with missing information.