CPT 36475 Endovenous RFA Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 36475: Endovenous Radiofrequency Ablation of Extremity Vein

CPT code 36475 denotes endovenous radiofrequency ablation of a diseased extremity vein, reported for the first vein treated. This minimally invasive, percutaneous procedure uses a radiofrequency probe to thermally destroy the venous wall and close the vein, commonly employed for symptomatic varicose or refluxing superficial veins. Nationally, the code is significant for vascular surgery, interventional radiology and ambulatory surgery billing, shaping outpatient vascular care patterns and reimbursement discussions.

Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. These payers drive coverage criteria and preauthorization practices that affect utilization and site-of-service choices for endovenous ablation procedures.

Readers will find an overview of clinical context, typical sites of service, common billing modifiers, and payer coverage patterns. The publication summarizes benchmarks and policy considerations relevant to coding and claims submission for CPT code 36475, clarifies when this code is reported (first vein treated), and outlines the operational implications for outpatient vascular service lines. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 36475endovenous ablationradiofrequency ablationvascular surgeryambulatory surgeryoutpatient procedurevenous diseaseprocedure coding

Billing Code Overview

CPT code 36475 describes a procedure in which a provider inserts a specially designed radiofrequency probe through the skin and destroys the wall of a diseased vein in an extremity. This is a minimally invasive endovenous radiofrequency ablation procedure performed to treat symptomatic or problematic peripheral veins.

Service Type: Endovenous radiofrequency ablation (peripheral venous procedure)

Typical Site of Service: Hospital outpatient department, ambulatory surgery center, or vascular clinic with procedure capability

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 52-year-old ambulatory adult presenting to an outpatient vascular clinic with symptomatic varicose veins of the lower extremity, reporting pain, heaviness, and occasional swelling. Duplex ultrasound mapping confirms an insufficient great saphenous vein (GSV) with reflux. After conservative management (compression therapy, lifestyle modification) failed or patient preference for definitive therapy, the vascular surgeon or interventional radiologist schedules endovenous radiofrequency ablation. The procedure is performed in an outpatient vascular lab or ambulatory surgical center under ultrasound guidance with local tumescent anesthesia. The provider inserts a specially designed radiofrequency probe percutaneously into the diseased vein and delivers thermal energy to ablate the vein wall, starting with the first treated vein reported with 36475. Post-procedure duplex ultrasound verifies vein closure and identifies any thrombotic complication. Typical workflow steps: patient check-in and informed consent, pre-procedure ultrasound mapping, sterile preparation and local anesthesia, ultrasound-guided catheter/probe insertion, delivery of radiofrequency energy to ablate the target vein, post-ablation ultrasound surveillance, application of compression dressing, discharge with post-procedure instructions and follow-up visit for clinical and ultrasound reassessment.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component

CPT 36479: Endovenous Laser Ablation, Additional Vein

CPT-36474-MECHANOCHEMICAL-ABLATION-ADDITIONAL-VARICOSE-VEIN

CPT 36474: Mechanochemical Ablation of Additional Incompetent Vein(s)

CPT-36483-ADD-ON-CHEMICAL-ADHESIVE-ABLATION-EXTREMITY

CPT 36483: Add-On Chemical Adhesive Ablation of Subsequent Extremity Veins

CPT-36476-ENDOVENOUS-RADIOFREQUENCY-ABLATION-ADD-ON

CPT 36476: Endovenous Radiofrequency Ablation, Additional Vein

CPT-36473-MECHANOCHEMICAL-ABLATION-FIRST-VEIN-VARICOSE-VEIN-TREATMENT

CPT 36473: Image-Guided Mechanochemical Ablation for Varicose Vein, First Vein

CPT-36478-ENDOVENOUS-LASER-ABLATION-FIRST-VEIN

CPT 36478: Endovenous Laser Ablation of First Diseased Vein

Taxonomy Code	Specialty	Notes
207P00000X	Vascular Surgery	Common specialty performing endovenous radiofrequency ablation.
2080P0207X	Interventional Radiology	Common specialty performing image-guided endovenous procedures.
330K00000X	Cardiovascular Disease (Phlebology)	Specialists focused on venous disease and ablation therapies.
2086S0124X	General Surgery	General surgeons with vascular interest may perform this procedure.
363L00000X	Family Medicine	In some practices with procedural training, family medicine physicians with vascular procedural privileges may perform the procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I83.90`	Varicose veins of lower extremities with unspecified complications, unspecified lower extremity	Common primary diagnosis prompting endovenous ablation for symptomatic varicose veins.
`I83.10`	Varicose veins of right lower extremity with pain	Localizes symptomatic disease to the right leg; supports medical necessity for `36475` on the right (`RT`).
`I83.11`	Varicose veins of left lower extremity with pain	Localizes symptomatic disease to the left leg; supports medical necessity for `36475` on the left (`LT`).
`I83.819`	Varicose veins of other right lower extremity with other complications	Captures varicose veins with complications such as edema or skin changes relevant to intervention.
`I87.2`	Venous insufficiency (chronic) (peripheral)	Underlying chronic venous insufficiency often treated by endovenous ablation to reduce reflux.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36475`	Endovenous thermal ablation of incompetent vein, radiofrequency; first vein treated	Primary procedure for percutaneous radiofrequency ablation of a single diseased extremity vein.
`36476`	Endovenous thermal ablation of incompetent vein, radiofrequency; additional vein, each additional vein treated	Used when one or more additional saphenous or accessory veins are treated in the same session after reporting `36475` for the first vein.
`93971`	Duplex scan of extremity veins; unilateral study, complete	Pre- and post-procedure diagnostic ultrasound mapping and surveillance to document reflux and closure.
`36478`	Endovenous thermal ablation of incompetent vein, laser; first vein treated	Alternative endovenous ablation modality (laser) used for the first vein; clinically comparable to radiofrequency technique.
`36482`	Endovenous ablation, non-thermal (chemical or mechanical), first vein treated	Alternative modality (chemical or mechanochemical) that may be used instead of thermal radiofrequency ablation.

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