Billing code 36465: Foam sclerotherapyMedicare rate & RVUs in Texas
Reports ultrasound-guided treatment of one incompetent truncal vein using noncompounded foam sclerosant for symptomatic venous reflux.
Medicare pays $1,178.00–$1,354.18 for 36465 in the office in Texas, from Beaumont to Austin. 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.
On this page 9 sections
What 36465 covers
This service treats venous reflux in one incompetent truncal vein, such as the great saphenous or an accessory saphenous vein. The clinician injects noncompounded foam sclerosant percutaneously and uses ultrasound and compression maneuvers to guide its spread and monitor treatment. Vascular specialists commonly perform it in an office or outpatient setting for patients with symptomatic varicose veins related to truncal reflux.
Report one unit for treatment of one qualifying truncal vein. Documentation should identify the treated vein and extremity, the reflux problem, and the foam treatment performed. Ultrasound guidance and monitoring for this treatment are included. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 results in payment at 150% for bilateral treatment. Assistant-at-surgery services are not paid; co-surgeons and team surgery 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 36465 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$1178.00 to $1354.18
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $1,354.18 | $104.63 |
| Beaumont | $1,178.00 | $103.24 |
| Brazoria | $1,272.94 | $102.51 |
| Dallas | $1,280.24 | $103.91 |
| Fort Worth | $1,268.51 | $103.98 |
| Galveston | $1,276.10 | $103.31 |
| Houston | $1,284.88 | $112.10 |
| Rest Of Texas | $1,224.15 | $103.33 |
How the 36465 rate is calculated
Each of 36465’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 · 36465
RVUs × geographic indexes × conversion factor
Work2.29
2.29 RVUs× 1.000 GPCI
Practice expense35.75
35.75 RVUs× 1.000 GPCI
Malpractice0.48
0.48 RVUs× 1.000 GPCI
Adjusted RVUs
38.5200
Conversion factor
$33.4009
Medicare rate
$1,286.60
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 36465
The CMS indicators that decide how 36465 is paid alongside other services.
CMS payment indicators · 36465
Foam sclerotherapy
| 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
36465 without 50 · national office
$1,286.60
Foam sclerotherapy
36465-50 · Bilateral: 150%
$1,929.90
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).
36465 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 36466Foam sclerotherapy
- Use 36465 for foam treatment of one incompetent truncal vein; 36466 is for treatment of multiple incompetent truncal veins.
- 36470Vein sclerotherapy
- 36470 covers sclerosant injection into one incompetent vein other than a telangiectasia. 36465 is specifically for noncompounded foam treatment of an incompetent truncal vein.
- 36471Sclerotherapy
- 36471 covers sclerosant injection into multiple incompetent veins other than telangiectasias. It is not the multiple-truncal-vein foam code; that is 36466.
- 36468Njx sclrsnt spider veins
- 36468 is for spider-vein sclerotherapy. Use 36465 for foam treatment of one incompetent truncal vein.
36465 billing questions
When should 36465 be used instead of 36466?
Use 36465 when one incompetent truncal vein is treated with noncompounded foam. Use 36466 when multiple incompetent truncal veins are treated.
Is ultrasound guidance separately reported with 36465?
No. Ultrasound guidance and monitoring used to direct and observe the foam treatment are included in 36465.
How many units are reported for one treated vein?
Report one unit for treatment of one qualifying truncal vein. The documentation should identify the treated vein and extremity.
How does 36465 differ from 36470 or 36471?
36465 is for noncompounded foam treatment of an incompetent truncal vein. Codes 36470 and 36471 describe sclerosant treatment of one or multiple other incompetent veins, rather than truncal-vein foam treatment.
How is bilateral treatment handled?
When bilateral treatment is reported with modifier 50, CMS payment is 150% of the single-procedure rate. Multiple procedures in the same session are subject to the standard reduction, with the highest-valued procedure paid in full and others at 50%.
Can an assistant surgeon or co-surgeon be reported?
CMS does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted.
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
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