Does Medicare pay for varicose vein treatment

Understanding Medicare Coverage for Varicose Vein Treatment: What You Need to Know 
Varicose veins are more than a cosmetic crisis for many people. They can cause swelling, aching, and other health complications. If you’re over 65 or qualify for Medicare due to disability, you might be wondering: Does Medicare pay for varicose vein treatment? The answer is not always clear, but this blog breaks it down for you in plain English. 
Let’s explore how Medicare treats varicose vein care, what procedures are typically covered, and how to reduce your out-of-pocket expenses. 
 

Does Medicare Pay for Varicose Vein Treatment? 

In short, Medicare may pay for varicose vein treatment, but only if it’s deemed medically necessary. Medicare does not cover procedures done only for cosmetic purposes, which is essential to keep in mind if you are looking to treat varicose veins for aesthetic reasons alone. 
However, if your varicose veins are inducing symptoms like pain, skin ulcers, or interfering with daily mobility, your doctor may categorize treatment as medically necessary. In those cases, Medicare coverage could apply. 

How Do Doctors Determine Whether Varicose Vein Treatment Is Considered Medically Necessary Under Medicare? 
Before Medicare will consider coverage, your physician typically has to document that your varicose veins are leading to significant health concerns. These may include: 

• Chronic leg pain or cramping 

• Skin discoloration or ulcers 

• Bleeding from the veins 

• Swelling that affects mobility 

• Risk of forming blood clots or other vascular complications 

 
In many cases, you may be required to try conservative treatment first, such as wearing compression stockings, elevating your legs, or making lifestyle changes. If those don’t help, then Medicare may approve more advanced interventions. 

Documentation is critical. Your doctor will need to submit medical records, photographs, ultrasound findings, and a treatment plan to justify the necessity of the procedure under Medicare’s rules. 
 

What Types of Varicose Vein Treatments Are Typically Covered by Medicare? 

Medicare Part B, which covers outpatient services, typically includes coverage for medically necessary varicose vein procedures. Some of the naturally covered treatments include: 

• Endovenous laser therapy (EVLT) 

• Radiofrequency ablation (RFA) 

• Sclerotherapy (only if medically indicated) 

• Vein stripping and ligation 

• Ambulatory phlebectomy 

 
Each of these procedures is evaluated on a case-by-case basis. Medicare requires evidence that these treatments are essential for your health rather than cosmetic improvements. 

For example, sclerotherapy, a standard treatment where a solution is injected into the vein to close it off, is often considered cosmetic unless symptoms are severe and persistent. 
 

What Is the Cost of Varicose Vein Surgery With Medicare Coverage? 

Once your treatment is approved, Medicare Part B generally covers 80% of the agreed amount for outpatient procedures. That leaves you liable for the remaining 20%, as well as any applicable deductible. In 2025, the Medicare Part B deductible is $240. 
Here’s a streamlined cost analysis for a procedure that Medicare approves: 

• Medicare-approved amount: $2,000 

• Medicare pays 80%: $1,600 

• You pay 20% coinsurance: $400 

• Plus any applicable Part B deductible 

If you have Medigap (Medicare Supplement Insurance), it may cover some or all of that 20% coinsurance. Always check your specific plan benefits before proceeding. 

 
What Alternative Treatments for Varicose Veins Are Available If Medicare Does Not Cover the Procedure? 

If Medicare doesn’t cover your procedure, typically because it’s cosmetic in nature, you still have options. Some alternatives include: 

• Compression therapy: Medicare often covers compression stockings if they are prescribed for a distinct medical condition, like venous insufficiency or chronic ulcers. 

• Lifestyle changes, including weight loss, regular movement, and elevating your legs, can reduce symptoms. 

• Out-of-pocket procedures: You can opt to pay for cosmetic treatments like cosmetic sclerotherapy, laser treatments, or foam therapy that Medicare does not cover. Costs differ depending on the clinic and region. 

Some patients also explore financing plans or health savings accounts (HSAs), though HSAs are generally used before enrolling in Medicare. 

 
What Are the Current Medicare Guidelines for Varicose Vein Treatment? 

Medicare guidelines are strict when it comes to distinguishing between medical necessity and cosmetic preferences. According to the Centers for Medicare & Medicaid Services (CMS), Medicare may cover varicose vein treatment when: 

• There is documented venous reflux or obstruction 

• The patient has symptoms that interfere with daily life 

• Conservative management has failed 

• The procedure is FDA-approved and clinically justified 

 
CMS also emphasizes the need for Doppler ultrasound evaluation before treatment to confirm venous insufficiency. 
For providers, billing codes like CPT 36475 (endovenous ablation) and 37765 (ligation and excision) are commonly used, but only reimbursed when justified under the above conditions. 

 
How Does Medicare Advantage Impact Coverage for Varicose Vein Treatment? 
Private insurers approved by Medicare offer Medicare Advantage (Part C) plans. These plans must protect the same services as Original Medicare, but they may propose additional benefits, such as: 

• Lower out-of-pocket costs 

• Broader coverage for treatments or consultations 

• Prescription drug coverage 

• Coordinated care with specialists 

 
That said, coverage specifics, including prior authorization requirements, provider networks, and copays, can vary widely between Medicare Advantage plans. You’ll need to check your plan’s Evidence of Coverage or call customer service for details. 
Some Medicare Advantage plans may also include transportation to medical appointments or post-op therapy, which can be valuable if your treatment plan includes follow-up care. 
 

How Much Can You Receive From Medicare Toward Varicose Vein Treatment Costs? 

 When Medicare approves your treatment, you can expect to receive up to 80% of the approved amount in coverage under Part B. The exact dollar amount will depend on: 

• The treatment type and setting (e.g., hospital vs. outpatient clinic) 

• Whether your provider accepts Medicare assignment 

• Your location and local Medicare pricing 

• Whether you have supplemental insurance 

 
If your treatment costs $3,000, Medicare might reimburse approximately $2,400. The remaining $600 would be your coinsurance, unless covered by a Medigap or Medicare Advantage plan. 

Keep in mind that Medicare will not reimburse you directly unless you’ve paid a provider out of pocket and filed a claim (which is rare). Typically, Medicare pays the provider or facility directly. 

 
Conclusion 
So, does Medicare pay for varicose vein treatment? The answer depends primarily on whether your symptoms are considered medical or cosmetic. If your varicose veins are impacting your health, causing pain, or leading to complications, Medicare may cover treatment. But you’ll need to work closely with your doctor to ensure the documentation meets Medicare’s medical necessity requirements. 
Note: Always speak with your provider and Medicare plan representative before scheduling treatment. That way, you can be sure you’re getting both the care you need and the coverage you’re entitled to. 
Disclaimer: This article is for informational purposes only. Medicare coverage and costs can vary by region, plan type, and individual circumstances. Always speak directly with your provider or Medicare representative for the most accurate information. 
 
Source: healthcare.gov