Does Medicare Cover Varicose Vein Treatment?

Varicose veins are veins that are abnormally enlarged or twisted, most commonly found in the legs. Spider veins, a milder form of this condition resembling a spider web with a reddish or bluish color, may be found on the face as well as the legs.

Under normal conditions, blood travels freely in one direction toward your heart through valves situated in your veins. But if blood flows backward and pools up, it increases pressure in the vein walls, causing them to stretch and weaken, leading to damaged valves. This can manifest in varicose or spider veins.

Medical versus cosmetic

If varicose veins are severe, blood clots can develop. This condition is known as deep vein thrombosis, which requires immediate medical attention. Your doctor can check your blood flow with a vascular ultrasound. 

However, varicose veins are not usually classified as a serious medical condition. If you have no symptoms, you may not need medical treatment. If you choose to undergo treatment for cosmetic purposes, Medicare insurance will not cover it. Medicare insurance is limited to services, procedures, supplies and treatments that are medically necessary.

Varicose vein treatments

The American Academy of Dermatology Association (AAD) describes treatments used by dermatologists, ranging from self-care to minor surgery. These treatments include:

• Exercise, leg elevation, and avoidance of sitting, standing, or hot baths for extended periods
• Wearing compression stockings to help push the blood back to your heart, reduce swelling and mitigate the risk of blood clots
• Sclerotherapy, the most common treatment, entails injecting chemicals into the vein to stop the blood flow through the vein, improve circulation and reduce swelling
• Laser treatments for spider veins and small varicose veins destroy the vein without damaging the skin
• Endovenous laser therapy (EVLT) and radiofrequency ablation (RFA), which involves heat that causes the vein to collapse and then seal shut 

Medicare coverage for varicose vein treatments

The Centers for Medicare & Medicaid Services (CMS) states that procedures to address spider veins are typically done for cosmetic reasons and, therefore, Medicare insurance does not cover it. 

Medicare may consider varicose vein treatment medically necessary if you remain symptomatic following six weeks of conservative therapy. 

Symptoms include:

• Stasis ulcer in the lower leg
• Severe pain and swelling that disrupts daily activities
• Bleeding related to disease of lower extremity vessels
• Phlebitis (vein inflammation)
• Stasis dermatitis
• Resistant dependent edema (swelling)

Conservative therapy includes:

• Weight reduction
• Daily exercise regimen
• Periodic elevation of the leg
• Compression stockings

If your doctor documents that six weeks of conservative therapy have failed to get rid of your symptoms, Medicare may approve the following treatments:

• Surgical ligation and stripping
• Sclerotherapy
• Radiofrequency ablation 
• Laser ablation

Resources

Sources of additional information about varicose vein treatments and Medicare coverage:

• American Academy of Dermatology Association (AAD)
• John Hopkins Medicine
• CMS Medicare Coverage Database