CPT 36476 Endovenous Ablation Reimbursement | OpenPayer

Summary & Overview

CPT 36476: Endovenous Radiofrequency Ablation, Additional Vein

CPT code 36476 represents an add-on endovenous radiofrequency ablation procedure used to ablate additional diseased veins in an extremity during the same session as an initial vein ablation. This code captures incremental work and resources when multiple veins are treated in one encounter and is relevant for vascular surgeons, interventional radiologists, and clinics that perform ambulatory vein procedures. Nationally, accurate reporting of add-on ablation services affects aggregated utilization metrics and reimbursement patterns for peripheral venous interventions.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for using CPT code 36476, comparisons of payer coverage approaches, and benchmarks for common billing practices. The publication highlights coding and billing considerations tied to service setting and procedure sequencing, plus policy updates and payer-specific guidance where available. The content is intended for coding professionals, revenue-cycle staff, and clinical leaders seeking a national perspective on how add-on endovenous ablation is reported and reimbursed.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare36476CPTendovenous ablationradiofrequency ablationvascular surgeryinterventional radiologyoutpatient proceduresambulatory surgery

Billing Code Overview

CPT code 36476 describes an add-on radiofrequency ablation procedure in which a provider inserts a specially designed radiofrequency probe through the skin to destroy the wall of a diseased vein in an extremity. The procedure is performed to ablate additional veins in the same session as the initial vein ablation.

Service type: Endovenous radiofrequency ablation (add-on procedure) performed percutaneously
Typical site of service: Outpatient vascular or interventional suite, ambulatory surgery center, or hospital outpatient department

Clinical & Coding Specifications

Clinical Context

A typical patient is a 55-year-old ambulatory adult presenting to an outpatient vascular clinic with symptomatic varicose veins of the lower extremity characterized by pain, aching, heaviness, and visible bulging superficial veins. Duplex ultrasound confirms reflux in the great saphenous vein or a similar truncal superficial vein. The provider performs endovenous radiofrequency ablation under ultrasound guidance in a procedure suite or ambulatory surgery center. After obtaining informed consent and local tumescent anesthesia, the provider gains percutaneous access to the target vein, advances a radiofrequency catheter, delivers energy to ablate the vein, and removes the catheter. When additional diseased veins are identified and treated during the same session, the provider bills the primary endovenous ablation code for the initial vein and uses this add-on code 36476 for each additional vein ablated in the same session. Typical workflow includes pre-procedure duplex mapping, procedure documentation of access sites and energy delivery, and post-procedure compression instructions and follow-up duplex within several weeks. Typical site of service is an outpatient vascular clinic procedure room, ambulatory surgery center, or hospital outpatient department.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When reporting only the physician component of a bundled service (rare for this procedure but applicable when imaging component is billed separately).

CPT 36475: Endovenous Radiofrequency Ablation of Extremity Vein

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

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

CPT-36479-ENDOVENOUS-LASER-ABLATION-ADD-ON-PROCEDURE

CPT 36479: Endovenous Laser Ablation, Additional Vein

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

CPT 36478: Endovenous Laser Ablation of First Diseased Vein

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

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

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

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

Taxonomy Code	Specialty	Notes
207P00000X	Vascular Surgery	Common specialty performing endovenous ablation procedures.
208D00000X	Dermatology	Some dermatologists with vascular/interventional training perform saphenous ablation for varicose veins.
208600000X	General Surgery	General surgeons with vascular interest frequently perform endovenous procedures.
2084P0800X	Interventional Cardiology	Interventionalists occasionally perform peripheral venous procedures in specialized practices.
207L00000X	Interventional Radiology	Interventional radiologists commonly perform ultrasound-guided endovenous ablation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I83.011`	Varicose veins of left lower extremity with pain	Common indication for endovenous ablation to treat symptomatic truncal reflux.
`I83.013`	Varicose veins of left lower extremity with ulceration	Ablation may be part of comprehensive care for venous ulcers with underlying reflux.
`I83.111`	Varicose veins of right lower extremity with pain	Symptomatic varicosities on the right side frequently treated with ablation.
`I83.813`	Varicose veins of bilateral lower extremities with other complications	When multiple limbs or complications are present, additional veins may be ablated in the same session.
`I87.2`	Venous insufficiency (chronic) (peripheral)	Underlying pathophysiology targeted by endovenous ablation to eliminate reflux and improve symptoms.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36475`	Endovenous ablation therapy of incompetent vein, inclusive of all imaging and monitoring; first vein treated in a single extremity, radiopaque or radiofrequency catheter-based	Primary code for the initial endovenous radiofrequency ablation of a truncal vein; `36476` is reported in addition for each subsequent vein treated in the same session.
`36478`	Endovenous laser ablation of incompetent vein, inclusive of all imaging and monitoring; first vein treated in a single extremity	Alternative primary modality (laser) for initial truncal vein ablation; may be performed in the same episode of care when laser is the chosen energy source.
`93970`	Duplex scan of extremity veins, complete bilateral study	Pre- and post-procedure diagnostic mapping and surveillance to document reflux and treatment results.
`36465`	Endovenous ablation therapy of incompetent vein, inclusive of all imaging and monitoring; initial treatment of a single incompetent vein using radiofrequency	Sometimes used interchangeably depending on payer; documents endovenous thermal ablation of a single vein.
`36471`	Endovenous ablation therapy of incompetent vein, literal code alternatives for subsequent veins (if applicable)	Codes for subsequent treatments or alternative reporting by payer; used to report additional treated veins when payer requires alternative coding.
`99024`	Postoperative follow-up visit, postoperative global period	Office follow-up visit related to the procedure during the global period; used per payer rules for routine follow-up care.

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