Aetna Sclerotherapy (Varicose Veins) prior authorization requirements (2026)
What Aetna generally requires to approve Sclerotherapy (Varicose Veins) (CPT 36465, 36466, 36468, 36470, 36471), for Commercial plans. Yes. Aetna generally requires prior authorization for Sclerotherapy (Varicose Veins) (CPT 36465, 36466, 36468, 36470, 36471).
Medical-necessity criteria Aetna generally applies
Per Aetna CPB 0050, sclerotherapy (liquid or foam; 36465/36466/36470/36471) is medically necessary when the vein is 2.5 mm or greater in diameter by recent ultrasound AND a symptomatic indication is met (intractable ulceration; more than one minor or a single significant hemorrhage; or, after a 3-month conservative trial with >=20 mmHg compression, recurrent superficial thrombophlebitis or severe persistent pain/swelling interfering with ADLs). If saphenofemoral/saphenopopliteal junctional reflux is present, the junction must be treated by ablation or ligation first. Up to two sets of injections per affected leg.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Sclerotherapy (Varicose Veins). Confirm the covered diagnosis list against the current Aetna policy.
Related procedure codes
Codes often billed alongside Sclerotherapy (Varicose Veins): 36465, 36466, 36468, 36470, 36471. Verify the correct codes for your documentation.
Commonly required documentation
- Ultrasound documenting vein diameter >=2.5 mm
- symptom and conservative-care documentation
- if junctional reflux present, evidence the junction is being treated.
Situations to verify before submitting
Aetna may not cover Sclerotherapy (Varicose Veins) in these situations. Verify against the current policy rather than assuming a denial:
- Sclerotherapy of veins less than 2.5 mm in diameter and for all other indications is cosmetic / not medically necessary
- Spider veins / telangiectasias (CPT 36468) - cosmetic
- Sclerotherapy for reflux of the iliac veins, saphenofemoral junction, or saphenopopliteal junction - experimental/investigational
How to submit
- Method: Aetna precertification (Availity)
- Portal: Availity
Source
Source: Aetna CPB 0050 Varicose Veins. Precert per member plan. Last verified 2026-06-17.
Frequently asked questions
Does Aetna require prior authorization for Sclerotherapy (Varicose Veins)?
Yes. Aetna generally requires prior authorization for Sclerotherapy (Varicose Veins) (CPT 36465, 36466, 36468, 36470, 36471).
What does Aetna require to approve Sclerotherapy (Varicose Veins)?
Per Aetna CPB 0050, sclerotherapy (liquid or foam; 36465/36466/36470/36471) is medically necessary when the vein is 2.5 mm or greater in diameter by recent ultrasound AND a symptomatic indication is met (intractable ulceration; more than one minor or a single significant hemorrhage; or, after a 3-month conservative trial with >=20 mmHg compression, recurrent superficial thrombophlebitis or severe … Always confirm against the current Aetna policy.
How long does a Aetna prior authorization take?
Turnaround varies by plan and submission method. Check the Aetna portal for current timeframes.
Submitting Sclerotherapy (Varicose Veins) to Aetna?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.