Cigna Sclerotherapy (Varicose Veins) prior authorization requirements (2026)
What Cigna generally requires to approve Sclerotherapy (Varicose Veins) (CPT 36465, 36466, 36468, 36470, 36471), for Commercial plans. Yes. Cigna generally requires prior authorization for Sclerotherapy (Varicose Veins) (CPT 36465, 36466, 36468, 36470, 36471).
Medical-necessity criteria Cigna generally applies
Per Cigna eviCore (Treatment of Varicose Saphenous Vein Tributaries), sclerotherapy or phlebectomy of tributary/unnamed varicose veins is medically necessary when ALL: (1) duplex or ruler measurement within 6 months shows varicosities >=6 mm, OR >=3 mm with >=500 ms reflux; (2) a documented symptom (significant pain/heaviness/achiness/fatigue/throbbing after prolonged standing, or refractory venous edema interfering with ADLs) despite a >=6-week conservative-therapy trial; and (3) history of venous ulcer, bleeding, superficial phlebitis, or a failed recent 6-week provider-directed conservative trial. Treatment of underlying saphenovenous reflux should precede or be concurrent with tributary treatment. Spider/reticular sclerotherapy of veins under 3 mm is covered only for spontaneous bleeding or with venous-stasis ulceration.
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 Cigna 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
- Duplex or ruler measurement (within 6 months) of varicosity size and reflux
- symptom and 6-week conservative-therapy documentation.
Situations to verify before submitting
Cigna may not cover Sclerotherapy (Varicose Veins) in these situations. Verify against the current policy rather than assuming a denial:
- Sclerotherapy of spider/reticular veins under 3 mm (except spontaneous bleeding or venous-stasis ulceration) - cosmetic
- Staged phlebectomy/sclerotherapy less than 12 weeks after endovenous ablation - not medically necessary
How to submit
- Method: eviCore (evicore.com)
- Portal: eviCore by Evernorth
Source
Source: Cigna eviCore Peripheral Vascular Intervention (PVI.202.A, v1.0.2025, eff 2025-06-02). Last verified 2026-06-17.
Frequently asked questions
Does Cigna require prior authorization for Sclerotherapy (Varicose Veins)?
Yes. Cigna generally requires prior authorization for Sclerotherapy (Varicose Veins) (CPT 36465, 36466, 36468, 36470, 36471).
What does Cigna require to approve Sclerotherapy (Varicose Veins)?
Per Cigna eviCore (Treatment of Varicose Saphenous Vein Tributaries), sclerotherapy or phlebectomy of tributary/unnamed varicose veins is medically necessary when ALL: (1) duplex or ruler measurement within 6 months shows varicosities >=6 mm, OR >=3 mm with >=500 ms reflux; (2) a documented symptom (significant pain/heaviness/achiness/fatigue/throbbing after prolonged standing, or refractory venou… 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 Sclerotherapy (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.