CPT code 36478: Laser vein ablation, first vein treated2026 Medicare rate & RVUs in California
Reports percutaneous laser closure of the first incompetent extremity vein treated for venous reflux, with imaging guidance and procedural monitoring included.
Medicare pays $1,040.40–$1,323.30 for 36478 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 36478 covers
A clinician advances a laser fiber through a percutaneous access into an incompetent superficial vein and uses thermal energy to close it. The service is commonly performed for refluxing veins such as the great or small saphenous vein by vascular surgeons, interventional radiologists, and other clinicians trained in venous procedures. It may be performed in an office or outpatient facility. Imaging guidance and monitoring during the ablation are part of the service.
Report 36478 for the first vein treated; use 36479 for each additional vein treated in the same extremity through a separate access site. Documentation should identify the treated vein, support its incompetence and the clinical need for treatment, and describe the laser technique. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery payment is barred, and co-surgeon and team-surgery billing are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 36478 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$1040.40 to $1323.30
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $1,043.40 | $239.50 |
| Chico, CA | $1,040.40 | $236.50 |
| El Centro, CA | $1,040.58 | $236.68 |
| Fresno, CA | $1,040.40 | $236.50 |
| Hanford, CA | $1,040.40 | $236.50 |
| Los Angeles, CA | $1,116.30 | $248.59 |
| Madera, CA | $1,040.40 | $236.50 |
| Marin County, CA | $1,293.23 | $259.02 |
| Merced, CA | $1,040.40 | $236.50 |
| Modesto, CA | $1,040.40 | $236.50 |
| Napa, CA | $1,218.53 | $251.80 |
| Oxnard, CA | $1,111.79 | $244.81 |
| Redding, CA | $1,040.40 | $236.50 |
| Rest of California | $1,040.40 | $236.50 |
| Riverside, CA | $1,052.11 | $248.21 |
| Sacramento, CA | $1,095.35 | $242.31 |
| Salinas, CA | $1,091.40 | $241.29 |
| San Benito County, CA | $1,323.30 | $265.62 |
| San Diego, CA | $1,119.98 | $242.74 |
| San Francisco, CA | $1,291.99 | $257.78 |
| San Luis Obispo, CA | $1,073.56 | $238.12 |
| Santa Clara County, CA | $1,318.24 | $260.56 |
| Santa Cruz, CA | $1,132.86 | $241.68 |
| Santa Maria, CA | $1,096.28 | $241.04 |
| Santa Rosa, CA | $1,144.44 | $243.73 |
| Stockton, CA | $1,040.40 | $236.50 |
| Vallejo, CA | $1,216.75 | $250.02 |
| Visalia, CA | $1,040.40 | $236.50 |
| Yuba City, CA | $1,040.40 | $236.50 |
How the 36478 rate is calculated
Each of 36478’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 36478
RVUs × geographic indexes × conversion factor
Work5.17
5.17 RVUs× 1.000 GPCI
Practice expense23.09
23.09 RVUs× 1.000 GPCI
Malpractice1.09
1.09 RVUs× 1.000 GPCI
Adjusted RVUs
29.3500
Conversion factor
$33.4009
Medicare rate
$980.32
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 36478
The CMS indicators that decide how 36478 is paid alongside other services.
CMS payment indicators · 36478
Laser vein ablation, first vein treated
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
36478 without 50 · national office
$980.32
Laser vein ablation, first vein treated
36478-50 · Bilateral: 150%
$1,470.48
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
36478 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 36479Laser vein ablationEach additional vein
- 36478 covers the first vein treated with laser; 36479 is the add-on for each additional vein treated in the same extremity through a separate access site.
- 36475Venous ablationRadiofrequency, first vein
- Both are first-vein endovenous ablation services, but 36478 uses laser energy and 36475 uses radiofrequency.
- 36473Vein ablationMechanochemical, first vein
- 36478 uses laser thermal energy; 36473 uses a mechanochemical technique for the first vein.
- 36482Vein ablationChemical adhesive, first vein
- 36478 closes the vein with laser energy, whereas 36482 uses chemical adhesive for the first vein.
36478 billing questions
When should 36478 be used instead of 36479?
Use 36478 for the first vein treated with laser ablation. Report 36479 for each additional vein treated in the same extremity through a separate access site.
Are ultrasound guidance and monitoring separately reported?
Imaging guidance and monitoring for the laser ablation are included in 36478.
How is bilateral laser ablation handled?
CMS lists modifier 50 for bilateral treatment and pays the procedure at 150%.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Can an assistant, co-surgeon, or surgical team be billed?
Assistant-at-surgery payment is restricted. Co-surgeons and team surgery are not permitted for this code.
What documentation supports the first-vein code?
Document the incompetent vein treated, the clinical basis for treatment, and that laser ablation was performed. Identify additional veins separately when reporting 36479.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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