Medicare Benefits Schedule - Note TN.8.33

Claiming Guide for the following procedures:

1. Sclerotherapy (Item 32500)
2. Surgical Dissection and Ligation (Items 32507, 32508, 32511, 32514, 32517)
3. Endovenous Laser Therapy (Items 32520 and 32522) 
4. Radiofrequency Ablation (Items 32523 and 32526)
5. Cyanoacrylate adhesive (Items 32528 and 32529)

It is recommended that the medical practitioner performing the above procedures has successfully completed a substantial course of study and training in duplex ultrasound and the management of venous disease, which has been endorsed by their relevant professional organisation.

It is recommended that providers familiarise themselves with the symptoms to be used to assess the severity of chronic venous disease as indicated in the item descriptor. Providers should also refer to the latest Clinical impact, Etiology/Aetiology, Anatomy and Pathophysiology (CEAP) classification description for symptoms, to help determine when intervention is required.

Related Items: 32500 32507 32508 32511 32514 32517 32520 32522 32523 32526 32528 32529

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• Next - Note TN.8.34

Multiple Operation Rule

Varicose veins, multiple injections of sclerosant using continuous compression techniques, including associated consultation, one or both legs, if:

(a) proximal reflux of 0.5 seconds or longer has been demonstrated; and

(b) the service is not for cosmetic purposes; and

(c) the service is not associated with:

(i) any other varicose vein operation on the same leg (excluding aftercare); or

(ii) a service on the same leg (excluding aftercare) to which any of the following items apply:

(A) 35200;

(B) 59970 to 60078;

(C) 60500 to 60509;

(D) 61109

Applicable to a maximum of 6 treatments in a 12 month period

(Anaes.)

Fee: $120.85 Benefit: 75% = $90.65 85% = $102.75

(See para TN.8.4, TN.8.32, TN.8.33, TN.8.228 of explanatory notes to this Category)

Multiple Operation Rule

Varicose veins, sub‑fascial ligation of one or more incompetent perforating veins in one leg of a patient, if the service:

(a) is performed by open surgical technique (not including endoscopic ligation) and the patient has significant signs or symptoms (including one or more of the following signs or symptoms) attributable to venous reflux:

(i) ache;

(ii) pain;

(iii) tightness;

(iv) skin irritation;

(v) heaviness;

(vi) muscle cramps;

(vii) limb swelling;

(viii) discolouration;

(ix) discomfort;

(x) any other signs or symptoms attributable to venous dysfunction; and

(b) is not associated with:

(i) any other varicose vein operation on the same leg; or

(ii) a service (on the same leg) to which item 35200, 60072, 60075 or 60078 applies

(H)

(Anaes.) (Assist.)

Fee: $587.35 Benefit: 75% = $440.55

(See para TN.8.32, TN.8.33 of explanatory notes to this Category)

Multiple Operation Rule

Varicose veins, complete dissection at the sapheno‑femoral or sapheno‑popliteal junction, with or without either ligation or stripping, or both, of the great or small saphenous veins in one leg of a patient, for the first time on the same leg, including excision or injection of either tributaries or incompetent perforating veins, or both, if the patient has significant signs or symptoms (including one or more of the following signs or symptoms) attributable to venous reflux:

(a) ache;

(b) pain;

(c) tightness;

(d) skin irritation;

(e) heaviness;

(f) muscle cramps;

(g) limb swelling;

(h) discolouration;

(i) discomfort;

(j) any other signs or symptoms attributable to venous dysfunction

(H)

(Anaes.) (Assist.)

Fee: $587.35 Benefit: 75% = $440.55

(See para TN.8.32, TN.8.33 of explanatory notes to this Category)

Multiple Operation Rule

Varicose veins, complete dissection at the sapheno‑femoral and sapheno‑popliteal junction, with or without either ligation or stripping, or both, of the great or small saphenous veins in one leg of a patient, for the first time on the same leg, including excision or injection of either tributaries or incompetent perforating veins, or both, if the patient has significant signs or symptoms (including one or more of the following signs or symptoms) attributable to venous reflux:

(a) ache;

(b) pain;

(c) tightness;

(d) skin irritation;

(e) heaviness;

(f) muscle cramps;

(g) limb swelling;

(h) discolouration;

(i) discomfort;

(j) any other signs or symptoms attributable to venous dysfunction

(H)

(Anaes.) (Assist.)

Fee: $873.20 Benefit: 75% = $654.90

(See para TN.8.32, TN.8.33 of explanatory notes to this Category)

Multiple Operation Rule

Varicose veins, ligation of the great or small saphenous vein in the same leg of a patient, with or without stripping, by re‑operation for recurrent veins in the same territory—one leg—including excision or injection of either tributaries or incompetent perforating veins, or both, if the patient has significant signs or symptoms (including one or more of the following signs or symptoms) attributable to venous reflux:

(a) ache;

(b) pain;

(c) tightness;

(d) skin irritation;

(e) heaviness;

(f) muscle cramps;

(g) limb swelling;

(h) discolouration;

(i) discomfort;

(j) any other signs or symptoms attributable to venous dysfunction

(H)

(Anaes.) (Assist.)

Fee: $1,020.15 Benefit: 75% = $765.15

(See para TN.8.32, TN.8.33 of explanatory notes to this Category)

Multiple Operation Rule

Varicose veins, ligation of the great and small saphenous vein in the same leg of a patient, with or without stripping, by re‑operation for recurrent veins in either territory—one leg—including excision or injection of either tributaries or incompetent perforating veins, or both, if the patient has significant signs or symptoms (including one or more of the following signs or symptoms) attributable to venous reflux:

(a) ache;

(b) pain;

(c) tightness;

(d) skin irritation;

(e) heaviness;

(f) muscle cramps;

(g) limb swelling;

(h) discolouration;

(i) discomfort;

(j) any other signs or symptoms attributable to venous dysfunction

(H)

(Anaes.) (Assist.)

Fee: $1,313.60 Benefit: 75% = $985.20

(See para TN.8.32, TN.8.33 of explanatory notes to this Category)

Multiple Operation Rule

Varicose veins, abolition of venous reflux by occlusion of a primary or recurrent great or small saphenous vein (and major tributaries of saphenous veins as necessary) in one leg of a patient, using a laser probe introduced by an endovenous catheter, if all of the following apply:

(a) it is documented by duplex ultrasound that the great or small saphenous vein (whichever is to be treated) of the patient demonstrates reflux of 0.5 seconds or longer;

(b) the patient has significant signs or symptoms (including one or more of the following signs or symptoms) attributable to venous reflux:

(i) ache;

(ii) pain;

(iii) tightness;

(iv) skin irritation;

(v) heaviness;

(vi) muscle cramps;

(vii) limb swelling;

(viii) discolouration;

(ix) discomfort;

(x) any other signs or symptoms attributable to venous dysfunction;

(c) the service does not include radiofrequency diathermy, radiofrequency ablation or cyanoacrylate adhesive;

(d) the service is not associated with a service (on the same leg) to which any of the following items apply:

(i) 32500 to 32507;

(ii) 35200;

(iii) 59970 to 60021;

(iv) 60036 to 60045;

(v) 60060 to 60078;

(vi) 60500 to 60509;

(vii) 61109

The service includes all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both)

(Anaes.)

Fee: $587.35 Benefit: 75% = $440.55 85% = $499.25

(See para TN.8.33 of explanatory notes to this Category)

Multiple Operation Rule

Varicose veins, abolition of venous reflux by occlusion of a primary or recurrent great and small saphenous vein (and major tributaries of saphenous veins as necessary) in one leg of a patient, using a laser probe introduced by an endovenous catheter, if all of the following apply:

(a) it is documented by duplex ultrasound that the great and small saphenous veins of the patient demonstrate reflux of 0.5 seconds or longer;

(b) the patient has significant signs or symptoms (including one or more of the following signs or symptoms) attributable to venous reflux:

(i) ache;

(ii) pain;

(iii) tightness;

(iv) skin irritation;

(v) heaviness;

(vi) muscle cramps;

(vii) limb swelling;

(viii) discolouration;

(ix) discomfort;

(x) any other signs or symptoms attributable to venous dysfunction;

(c) the service does not include radiofrequency diathermy, radiofrequency ablation or cyanoacrylate adhesive;

(d) the service is not associated with a service (on the same leg) to which any of the following items apply:

(i) 32500 to 32507;

(ii) 35200;

        (iii) 59970 to 60021;

        (iv) 60036 to 60045;

        (v) 60060 to 60078;

        (vi) 60500 to 60509;

        (vii) 61109 

The service includes all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both)

(Anaes.)

Fee: $873.20 Benefit: 75% = $654.90 85% = $774.50

(See para TN.8.33 of explanatory notes to this Category)

Multiple Operation Rule

Varicose veins, abolition of venous reflux by occlusion of a primary or recurrent great or small saphenous vein (and major tributaries of saphenous veins as necessary) in one leg of a patient, using a radiofrequency catheter introduced by an endovenous catheter, if all of the following apply:

(a) it is documented by duplex ultrasound that the great or small saphenous vein (whichever is to be treated) demonstrates reflux of 0.5 seconds or longer;

(b) the patient has significant signs or symptoms (including one or more of the following signs or symptoms) attributable to venous reflux:

(i) ache;

(ii) pain;

(iii) tightness;

(iv) skin irritation;

(v) heaviness;

(vi) muscle cramps;

(vii) limb swelling;

(viii) discolouration;

(ix) discomfort;

(x) any other signs or symptoms attributable to venous dysfunction;

(c) the service does not include endovenous laser therapy or cyanoacrylate adhesive;

(d) the service is not associated with a service (on the same leg) to which any of the following items apply:

(i) 32500 to 32507;

(ii) 35200;

        (iii) 59970 to 60021;

        (iv) 60036 to 60045;

        (v) 60060 to 60078;

        (vi) 60500 to 60509;

        (vii) 61109 

The service includes all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both)

(Anaes.)

Fee: $587.35 Benefit: 75% = $440.55 85% = $499.25

(See para TN.8.33 of explanatory notes to this Category)

Multiple Operation Rule

Varicose veins, abolition of venous reflux by occlusion of a primary or recurrent great and small saphenous vein (and major tributaries of saphenous veins as necessary) in one leg of a patient, using a radiofrequency catheter introduced by an endovenous catheter, if all of the following apply:

(a) it is documented by duplex ultrasound that the great and small saphenous veins demonstrate reflux of 0.5 seconds or longer;

(b) the patient has significant signs or symptoms (including one or more of the following signs or symptoms) attributable to venous reflux:

(i) ache;

(ii) pain;

(iii) tightness;

(iv) skin irritation;

(v) heaviness;

(vi) muscle cramps;

(vii) limb swelling;

(viii) discolouration;

(ix) discomfort;

(x) any other signs or symptoms attributable to venous dysfunction;

(c) the service does not include endovenous laser therapy or cyanoacrylate adhesive;

(d) the service is not associated with a service (on the same leg) to which any of the following items apply:

(i) 32500 to 32507;

(ii) 35200;

        (iii) 59970 to 60021;

        (iv) 60036 to 60045;

        (v) 60060 to 60078;

        (vi) 60500 to 60509;

        (vii) 61109 

The service includes all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both)

(Anaes.)

Fee: $873.20 Benefit: 75% = $654.90 85% = $774.50

(See para TN.8.33 of explanatory notes to this Category)

Multiple Operation Rule

Varicose veins, abolition of venous reflux by occlusion of a primary or recurrent great or small saphenous vein (and major tributaries of saphenous veins as necessary) in one leg of a patient, using cyanoacrylate adhesive, if all of the following apply:

(a) it is documented by duplex ultrasound that the great or small saphenous vein (whichever is to be treated) demonstrates reflux of 0.5 seconds or longer;

(b) the patient has significant signs or symptoms (including one or more of the following signs or symptoms) attributable to venous reflux:

(i) ache;

(ii) pain;

(iii) tightness;

(iv) skin irritation;

(v) heaviness;

(vi) muscle cramps;

(vii) limb swelling;

(viii) discolouration;

(ix) discomfort;

(x) any other signs or symptoms attributable to venous dysfunction;

(c) the service does not include radiofrequency diathermy, radiofrequency ablation or endovenous laser therapy;

(d) the service is not associated with a service (on the same leg) to which any of the following items apply:

(i) 32500 to 32507;

(ii) 35200;

        (iii) 59970 to 60021;

        (iv) 60036 to 60045;

        (v) 60060 to 60078;

        (vi) 60500 to 60509;

        (vii) 61109

The service include all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both)

(Anaes.)

Fee: $587.35 Benefit: 75% = $440.55 85% = $499.25

(See para TN.8.33 of explanatory notes to this Category)

Multiple Operation Rule

Varicose veins, abolition of venous reflux by occlusion of a primary or recurrent great and small saphenous vein (and major tributaries of saphenous veins as necessary) in one leg of a patient, using cyanoacrylate adhesive, if all of the following apply:

(a) it is documented by duplex ultrasound that the great and small saphenous veins demonstrate reflux of 0.5 seconds or longer;

(b) the patient has significant signs or symptoms (including one or more of the following signs or symptoms) attributable to venous reflux:

(i) ache;

(ii) pain;

(iii) tightness;

(iv) skin irritation;

(v) heaviness;

(vi) muscle cramps;

(vii) limb swelling;

(viii) discolouration;

(ix) discomfort;

(x) any other signs or symptoms attributable to venous dysfunction;

(c) the service does not include radiofrequency diathermy, radiofrequency ablation or endovenous laser therapy;

(d) the service is not associated with a service (on the same leg) to which any of the following items apply:

(i) 32500 to 32507;

(ii) 35200;

        (iii) 59970 to 60021;

        (iv) 60036 to 60045;

        (v) 60060 to 60078;

        (vi) 60500 to 60509;

        (vii) 61109

The service includes all preparation and immediate clinical aftercare (including excision or injection of either tributaries or incompetent perforating veins, or both)

(Anaes.)

Fee: $873.20 Benefit: 75% = $654.90 85% = $774.50

(See para TN.8.33 of explanatory notes to this Category)