Changes made to prior authorization request process for varicose vein procedures

Due to changes to our Treatment of varicose veins/venous insufficiency medical policy, we’ve changed the prior authorization process for varicose vein procedures.

Changes to questions presented in e-referral system
In late November 2023, we removed the following questionnaires from the e-referral system:

• Endovenous ablation for treatment of varicose veins — This previously opened for Medicare Plus Blue℠, Blue Care Network commercial and BCN Advantage℠ members for procedure codes *36473, *36474, *36482 and *36483.
• Varicose vein treatment — This questionnaire previously opened for BCN commercial and BCN Advantage members for procedure codes *36465, *36466, *36470, *36471, *36475, *36476, *36478, *36479, *37718, *37700, *37722, *37780, *37785, *37799 and S2202.

Instead of completing a questionnaire, the e-referral system now prompts you to answer a series of questions when submitting prior authorization requests. Here are the details:

• For procedure codes *36473, *36474 and *36482, the e-referral system will display questions when submitting requests for Medicare Plus Blue, BCN commercial and BCN Advantage members.
• For procedure codes *36465, *36466, *36470, *36471, *36475, *36478, *37718, *37700, *37722, *37780, *37785 and S2202, the e-referral system will display questions for BCN commercial and BCN Advantage members.
  
  Note: Procedure code *37799 continues to require prior authorization. Although you won’t be prompted to answer a series of questions when submitting prior authorization requests, you’ll have to complete the Experimental and investigational services questionnaire.
  

The e-referral system still either auto-approves or pends the request depending on your answers to the questions. For pended requests, you’ll need to submit additional clinical documentation.

How to access the updated medical policy
To view the updated medical policy:

1. Go to bcbsm.com/providers.
2. Click on Resources in the top navigation.
3. Click on the Search Medical Policies button.
4. Enter Treatment of varicose veins/venous insufficiency in the Policy/Topic Keyword field.
5. In the search results, click on the link to open the medical policy.

This policy includes requirements for endovenous ablation for the treatment of varicose veins.