Cigna Endovenous Ablation (Varicose Veins) prior authorization requirements (2026)
What Cigna generally requires to approve Endovenous Ablation (Varicose Veins) (CPT 36475, 36476, 36478, 36479), for Commercial plans. Yes. Cigna generally requires prior authorization for Endovenous Ablation (Varicose Veins) (CPT 36475, 36476, 36478, 36479).
Medical-necessity criteria Cigna generally applies
Prior authorization required; Cigna delegates to eviCore (Peripheral Vascular Intervention, Treatment of Saphenovenous Reflux). Medically necessary when BOTH: (A) symptoms documented by one of - venous ulcer of the lower leg, bleeding, or superficial phlebitis; OR documentation of BOTH a symptom (significant pain/heaviness/achiness/fatigue/throbbing after prolonged standing, refractory venous edema interfering with ADLs, or stasis dermatitis) AND an unsuccessful 8-week trial of conservative therapy including graded compression stockings plus exercise/elevation/weight loss; AND (B) a venous duplex within 6 months showing significant pathologic reflux of at least 500 ms in a vein to be treated (great, lesser, anterior accessory, or posterior accessory saphenous) and absence of DVT. Thermal (RFA/laser), cyanoacrylate (VenaSeal), mechanochemical, and foam are accepted ablation modalities.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Endovenous Ablation (Varicose Veins). Confirm the covered diagnosis list against the current Cigna policy.
Related procedure codes
Codes often billed alongside Endovenous Ablation (Varicose Veins): 36475, 36476, 36478, 36479. Verify the correct codes for your documentation.
Commonly required documentation
- Venous duplex (within 6 months) showing >=500 ms reflux and no DVT
- symptom documentation and the 8-week conservative-therapy trial.
Situations to verify before submitting
Cigna may not cover Endovenous Ablation (Varicose Veins) in these situations. Verify against the current policy rather than assuming a denial:
- Treatment of an asymptomatic state or for cosmesis is not medically necessary
How to submit
- Method: eviCore (evicore.com)
- Portal: eviCore by Evernorth
Source
Source: Cigna eviCore Peripheral Vascular Intervention guideline (PVI.201.C, v1.0.2025, eff 2025-06-02); supersedes legacy Cigna CP 0234. Conservative trial = 8 weeks for truncal saphenous reflux. Last verified 2026-06-17.
Frequently asked questions
Does Cigna require prior authorization for Endovenous Ablation (Varicose Veins)?
Yes. Cigna generally requires prior authorization for Endovenous Ablation (Varicose Veins) (CPT 36475, 36476, 36478, 36479).
What does Cigna require to approve Endovenous Ablation (Varicose Veins)?
Prior authorization required; Cigna delegates to eviCore (Peripheral Vascular Intervention, Treatment of Saphenovenous Reflux). Medically necessary when BOTH: (A) symptoms documented by one of - venous ulcer of the lower leg, bleeding, or superficial phlebitis; OR documentation of BOTH a symptom (significant pain/heaviness/achiness/fatigue/throbbing after prolonged standing, refractory venous edem… Always confirm against the current Cigna policy.
How long does a Cigna prior authorization take?
Turnaround varies by plan and submission method. Check the Cigna portal for current timeframes.
Submitting Endovenous Ablation (Varicose Veins) to Cigna?
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.