CPT 36465 Foam Sclerotherapy Reimbursement | OpenPayer

Summary & Overview

CPT 36465: Ultrasound-Guided Foam Sclerotherapy for Single Truncal Vein

CPT code 36465 denotes ultrasound-guided injection of a noncompounded foam sclerosing solution into a single incompetent truncal vein of an extremity, a common minimally invasive treatment for symptomatic varicose veins. Nationally, utilization of image-guided sclerotherapy is relevant to outpatient vascular care, venous disease management, and benefit design for procedural vein therapies. Payers commonly managing coverage and reimbursement for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

This publication provides a concise overview of CPT code 36465, including clinical context, expected service settings, and payer coverage landscape. Readers will find benchmarks for how the code is classified within outpatient procedural services, discussion of typical sites of service such as outpatient vascular clinics and ambulatory surgical centers, and a summary of policy and billing considerations relevant to national payers. The report also summarizes common modifiers associated with procedural billing and notes where input data is incomplete. This resource is intended for coding managers, billing teams, and policy analysts who need a focused briefing on the clinical and administrative aspects of ultrasound-guided foam sclerotherapy for a single truncal extremity vein.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare36465CPTsclerotherapyvenous-therapyultrasound-guidedoutpatient-procedurevascular-medicine

Billing Code Overview

CPT code 36465 describes ultrasound-guided injection of a noncompounded foam sclerosing solution into a single incompetent truncal vein of an extremity to guide foam dispersion, most commonly for treatment of a varicose vein. This procedure targets a single truncal vein and uses ultrasound imaging to ensure accurate placement and dispersion of the sclerosing foam.

Service type: Image-guided sclerotherapy of a single truncal extremity vein
Typical site of service: Outpatient vascular clinic, ambulatory surgical center, or office with ultrasound capability

Clinical & Coding Specifications

Clinical Context

A 54-year-old ambulatory patient presents to the vascular clinic with progressive symptomatic varicose veins of the lower extremity, describing aching, heaviness, and intermittent swelling that worsen with prolonged standing. Duplex ultrasound confirms a single incompetent great saphenous trunk with reflux. The vascular specialist discusses endovenous options and elects to perform ultrasound-guided foam sclerotherapy during an outpatient procedure visit. The workflow includes pre-procedure evaluation and consent, placement of sterile field in an ambulatory surgical center or office-based procedure room, ultrasound-guided cannulation of the target truncal vein, injection of a noncompounded sclerosant foam while monitoring dispersion under ultrasound, removal of the needle, application of compression dressing or stocking, brief post-procedure observation for complications, and discharge with activity and compression instructions. Typical site of service is an outpatient ambulatory surgical center or office-based procedure room. The service type is a minimally invasive ultrasound-guided venous intervention performed under local anesthesia or with monitored anesthesia care when indicated.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the physician's professional interpretation or service separate from technical components.

CPT 36468: Sclerotherapy Injections for Spider Veins

CPT-36466-FOAM-SCLEROTHERAPY-MULTIPLE-TRUNCAL-VEINS-SAME-LEG

CPT 36466: Ultrasound-Guided Foam Sclerotherapy for Multiple Truncal Veins

CPT-36471-SCLEROTHERAPY-MULTIPLE-INCOMPETENT-VEINS-LEG

CPT 36471: Sclerotherapy for Multiple Incompetent Veins in Same Leg

CPT-36470-SCLEROTHERAPY-VEIN-INJECTION-VARICOSE-VEIN

CPT 36470: Sclerotherapy Injection for Varicose Vein

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Taxonomy Code	Specialty	Notes
2080P0800X	Vascular Surgery	Common specialty performing truncal vein interventions.
208D00000X	Dermatology	Dermatologic surgeons often perform office-based sclerotherapy for venous disease.
213E00000X	Interventional Cardiology	Interventionalists with peripheral venous expertise may perform ultrasound-guided venous procedures.
207L00000X	Family Medicine	Family physicians with procedural training may perform office-based foam sclerotherapy.
363A00000X	Phlebology	Specialists in venous disease who frequently perform sclerotherapy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I83.011`	Varicose veins of right great saphenous vein with ulcer of thigh	Varicose truncal vein pathology treated by sclerotherapy to reduce reflux and symptoms.
`I83.012`	Varicose veins of left great saphenous vein with ulcer of thigh	Left-sided truncal varicosity with complications that may prompt intervention.
`I83.219`	Varicose veins of unspecified lower extremity with inflammation	Symptomatic varicose veins with inflammation indicating need for definitive therapy.
`I83.891`	Other specified varicose veins of lower extremities	Miscellaneous varicose vein presentations treated with sclerotherapy.
`I87.2`	Venous insufficiency (chronic) (peripheral)	Underlying chronic venous insufficiency leading to truncal vein incompetence addressed by sclerotherapy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36465`	Injection of noncompounded foam sclerosing solution, single incompetent truncal vein, extremity, with ultrasound guidance	Primary procedure: ultrasound-guided foam sclerotherapy for a single truncal vein.
`93970`	Duplex scan of extremity veins, complete bilateral study; noninvasive physiologic testing	Often performed pre- and post-procedure to document venous reflux and procedural outcome.
`36478`	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring	Alternative or adjunctive truncal vein treatment; may be performed when thermal ablation is chosen instead of sclerotherapy.
`99024`	Postoperative follow-up visit, typically during global period	Used for routine post-procedure follow-up within the global period when required by payer.
`99070`	Supplies and materials furnished by the physician over and above those usually included with the office visit	May be used to report special supplies (e.g., foam preparation kits) if payer allows separate supply billing.

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