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CPT code 36478: Laser vein ablation, first vein treated2026 Medicare rate & RVUs in Nevada

Reports percutaneous laser closure of the first incompetent extremity vein treated for venous reflux, with imaging guidance and procedural monitoring included.

CMS RVU26DEffective Oct 1, 2026One payment locality32.1K Medicare services in 2024

In Nevada, Medicare pays $975.01 for 36478 in the office and $240.79 when it’s performed in a hospital or facility.

$975.01Office (non-facility)
$240.79Hospital or facility
−0.5%vs the national office rate ($980.32)

Check a contract rate as a % of Medicare · 36478 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 36478 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Nevada
  2. What 36478 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Nevada compares for 36478

Across 109 of 109 payment localities, the office rate for 36478 runs from $853.92 in Arkansas to $1,323.30 in San Benito County, CA. Nevada pays $975.01. The RVUs are the same everywhere; the geographic indexes change the dollars.

36478 in Nevada vs other payment areas
  1. Nevada · this page$975.01
  2. Los Angeles, CA · California$1,116.30+$141.29
  3. Washington, DC area · District of Columbia$1,131.03+$156.02
  4. Miami, FL · Florida$1,067.60+$92.59
  5. Chicago, IL · Illinois$1,032.53+$57.52
  6. Manhattan, NY · New York$1,137.64+$162.63
  7. Alaska · Alaska$1,100.44+$125.43

Other areas in Nevada first, then benchmark localities. Bars start at $0.

Every other payment area

36478 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$868.11$226.31
ArkansasArkansas$853.92$223.85
ArizonaArizona$951.17$240.42
Bakersfield, CACalifornia$1,043.40$239.50
Chico, CACalifornia$1,040.40$236.50
El Centro, CACalifornia$1,040.58$236.68
Fresno, CACalifornia$1,040.40$236.50
Hanford, CACalifornia$1,040.40$236.50

36478 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$853.92

$1,181.85

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
36478 office rate range by state
State / territoryOffice rate rangeLocalities
AK$1,100.441
AL$868.111
AR$853.921
AZ$951.171
CA$1,040.40–$1,323.3029
CO$1,023.771
CT$1,050.801
DC$1,131.031
DE$968.251
FL$964.70–$1,067.603
GA$904.01–$1,000.492
GU$1,070.651
HI$1,070.651
IA$892.811
ID$899.431
IL$933.72–$1,032.534
IN$905.301
KS$888.221
KY$891.621
LA$890.10–$939.772
MA$1,016.56–$1,133.012
MD$988.31–$1,131.033
ME$904.86–$959.942
MI$917.92–$978.302
MN$977.051
MO$872.94–$943.373
MS$863.611
MT$980.241
NC$915.501
ND$958.691
NE$898.291
NH$1,007.391
NJ$1,061.71–$1,117.072
NM$923.621
NV$975.011
NY$930.94–$1,168.335
OH$913.511
OK$889.681
OR$966.42–$1,059.372
PA$915.07–$1,022.072
PR$988.251
RI$1,005.121
SC$916.241
SD$956.141
TN$893.281
TX$908.32–$1,021.248
UT$930.331
VA$956.50–$1,131.032
VI$988.251
VT$954.621
WA$1,014.74–$1,157.362
WI$922.731
WV$894.981
WY$970.851

See 36478 in every payment locality

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

Office or facility?

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.

The exact Nevada inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,490

Code
36478
Physician work
5.17
Practice expense
23.09
Malpractice
1.09

GPCI2026.csv

73

Locality
Nevada
Physician work
1.000
Practice expense
1.001
Malpractice
0.833
Office calculation for 36478 in Nevada
ComponentRVULocality factorAdjusted
Physician work5.17× 1.0005.1700
Practice expense23.09× 1.00123.1131
Malpractice1.09× 0.8330.9080
Total RVUs29.1911
Conversion factor× 33.4009

Office rate, Nevada$975.01

Office: (5.17 × 1 + 23.09 × 1.001 + 1.09 × 0.833) × $33.4009 = $975.01

Facility: (5.17 × 1 + 1.13 × 1.001 + 1.09 × 0.833) × $33.4009 = $240.79

Open 36478 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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).

When to use modifier 50

Codes related to 36478

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 36478
CodeHow it relatesOffice range, Nevada
Add-on codes
36479Laser vein ablation, each additional veinAdd-on for each additional vein treated by laser in the same extremity.$307.49
Used instead
36475Venous ablation, radiofrequency, first veinFirst-vein endovenous ablation using radiofrequency rather than laser.$1,050.57
36473Vein ablation, mechanochemical, first veinFirst-vein endovenous treatment using a mechanochemical method.$1,170.89
36482Vein ablation, chemical adhesive, first veinFirst-vein endovenous treatment using chemical adhesive.$1,654.69

How 36478 has changed in Nevada

36478 · Office / nonfacility

$975.01

Effective 2026-10-01

The base rate is $67.91 higher than on 2025-10-01, moving from $907.10 to $975.01 (7.5%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $907.10changed to$975.01

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 5.30 changed to 5.17
    • Practice expense RVU 21.84 changed to 23.09
    • Malpractice RVU 1.07 changed to 1.09
    • Practice expense GPCI 1.000 changed to 1.001
    • Malpractice GPCI 0.844 changed to 0.833

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $958.35changed to$907.10

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 22.57 changed to 21.84
    • Malpractice RVU 1.09 changed to 1.07

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $942.70changed to$958.35

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $1002.18changed to$942.70

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 23.11 changed to 22.57
    • Malpractice RVU 1.06 changed to 1.09
    • Malpractice GPCI 1.098 changed to 0.844

  5. January 1, 2023

    RVU23A

    $1067.08changed to$1002.18

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 24.09 changed to 23.11
    • Malpractice RVU 1.05 changed to 1.06
    • Work GPCI 1.005 changed to 1.000
    • Malpractice GPCI 1.351 changed to 1.098

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $1120.92changed to$1067.08

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 25.42 changed to 24.09
    • Malpractice RVU 1.02 changed to 1.05

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $1097.57changed to$1120.92

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 23.95 changed to 25.42
    • Malpractice RVU 1.01 changed to 1.02
    • Work GPCI 1.004 changed to 1.005
    • Malpractice GPCI 1.130 changed to 1.351

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $1169.76changed to$1097.57

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 25.80 changed to 23.95
    • Malpractice RVU 1.00 changed to 1.01
    • Work GPCI 1.002 changed to 1.004
    • Practice expense GPCI 1.017 changed to 1.000
    • Malpractice GPCI 0.909 changed to 1.130

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $1250.49changed to$1169.76

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 28.04 changed to 25.80

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $1256.49changed to$1250.49

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 27.78 changed to 28.04
    • Malpractice RVU 1.02 changed to 1.00
    • Work GPCI 1.004 changed to 1.002
    • Practice expense GPCI 1.034 changed to 1.017
    • Malpractice GPCI 0.946 changed to 0.909

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $1282.78changed to$1256.49

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 28.04 changed to 27.78
    • Malpractice RVU 1.05 changed to 1.02
    • Work GPCI 1.005 changed to 1.004
    • Practice expense GPCI 1.051 changed to 1.034
    • Malpractice GPCI 0.982 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $1279.08changed to$1282.78

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 27.81 changed to 28.04
    • Malpractice RVU 1.06 changed to 1.05

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $1272.71changed to$1279.08

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $1418.30changed to$1272.71

    • Conversion factor 35.8228 changed to 35.7547
    • Work RVU 6.72 changed to 5.30
    • Practice expense RVU 29.83 changed to 27.81
    • Malpractice RVU 1.26 changed to 1.06
    • Work GPCI 1.001 changed to 1.005
    • Practice expense GPCI 1.055 changed to 1.051
    • Malpractice GPCI 1.107 changed to 0.982

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $1496.32changed to$1418.30

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 33.68 changed to 29.83
    • Malpractice RVU 1.32 changed to 1.26
    • Work GPCI 1.000 changed to 1.001
    • Practice expense GPCI 1.058 changed to 1.055
    • Malpractice GPCI 1.232 changed to 1.107

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$1496.32

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$975.01$240.79RVU26D
2026-07-01$975.01$240.79RVU26C
2026-04-01$975.01$240.79RVU26B
2026-01-01$975.01$240.79RVU26A
2025-10-01$907.10$259.20RVU25D
2025-07-01$907.10$259.20RVU25C
2025-04-01$907.10$259.20RVU25B
2025-01-01$907.10$259.20RVU25A
2024-10-01$958.35$265.63RVU24D
2024-07-01$958.35$265.63RVU24C
2024-04-01$958.35$265.63RVU24B
2024-03-09$958.35$265.63RVU24AR
2024-01-01$942.70$261.30RVU24A
2023-10-01$1,002.18$278.68RVU23D
2023-07-01$1,002.18$278.68RVU23C
2023-04-01$1,002.18$278.68RVU23B
2023-01-01$1,002.18$278.68RVU23A
2022-10-01$1,067.08$294.33RVU22D
2022-07-01$1,067.08$294.33RVU22C
2022-04-01$1,067.08$294.33RVU22B
2022-01-01$1,067.08$294.33RVU22A
2021-10-01$1,120.92$295.35RVU21D
2021-07-01$1,120.92$295.35RVU21C
2021-04-01$1,120.92$295.35RVU21B
2021-01-01$1,120.92$295.35RVU21A
2020-10-01$1,097.57$296.39RVU20D
2020-07-01$1,097.57$296.39RVU20C
2020-04-01$1,097.57$296.39RVU20B
2020-01-01$1,097.57$296.39RVU20A
2019-10-01$1,169.76$288.66RVU19D
2019-07-01$1,169.76$288.66RVU19C
2019-04-01$1,169.76$288.66RVU19B
2019-01-01$1,169.76$288.66RVU19A
2018-10-01$1,250.49$289.07RVU18D
2018-07-01$1,250.49$289.07RVU18C
2018-04-01$1,250.49$289.07RVU18B
2018-01-01$1,250.49$289.07RVU18AR1
2017-10-01$1,256.49$292.03RVU17D
2017-07-01$1,256.49$292.03RVU17C
2017-04-01$1,256.49$292.03RVU17B
2017-01-01$1,256.49$292.03RVU17A
2016-10-01$1,282.78$295.74RVU16D
2016-07-01$1,282.78$295.74RVU16C
2016-04-01$1,282.78$295.74RVU16B
2016-01-01$1,282.78$295.74RVU16A
2015-10-01$1,279.08$297.16RVU15D
2015-07-01$1,279.08$297.16RVU15C
2015-04-01$1,272.71$295.68RVU15B
2015-01-01$1,272.71$295.68RVU15A
2014-10-01$1,418.30$376.73RVU14D
2014-07-01$1,418.30$376.73RVU14C
2014-04-01$1,418.30$376.73RVU14B
2014-01-01$1,418.30$376.73RVU14A
2013-10-01$1,496.32$372.88RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 36478 for an earlier date of service

Where the Nevada rate applies

Nevada is a Medicare payment area, not a city. Our Census mapping connects it to 138 cities and communities in Nevada. Some span more than one payment area; confirm with the service ZIP.

  • Alamo
  • Amargosa Valley
  • Austin
  • Baker
  • Battle Mountain
  • Beatty
  • Beaverdam
  • Bennett Springs

Browse all communities in Nevada

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

Show the CMS file lines behind this rate
RVUs for 36478PPRRVU2026_Oct_nonQPP.csv, line 4,490 (RVU26D)
Geographic factors for NevadaGPCI2026.csv, line 73 (RVU26D)

Open CMS sourceHow we calculate rates

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