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Medical Necessity Criteria Audit Checklist
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Patient demonstrates symptomatic chronic venous insufficiency
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Patient demonstrates objective duplex-confirmed venous reflux with correlating junctional reflux (>500 ms)
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Diameter of diseased veins documented ≥4.5mm
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Patient demonstrates persistent symptoms despite ≥3 months of documented conservative therapy
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Patient demonstrates functional impairment
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Medical Necessity Criteria for Endovenous Intervention
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Findings meet CMS and commercial payer medical necessity criteria for endovenous intervention due to:
• • •
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Procedural intervention is medically necessary to:
• • •
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Medical Necessity Statement
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