$301.49–$353.67
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.
On this page
CMS RVU26D · Effective 2026-10-01
36478 Laser vein ablation Medicare reimbursement rates in Virginia
Reports percutaneous laser closure of the first incompetent extremity vein treated for venous reflux, with imaging guidance and procedural monitoring included. Compare 36478 office and facility rates across CMS payment localities in Virginia.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 36478 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$956.50–$1131.03
2 of 2 localities have a supported rate.
Facility setting
$235.49–$266.99
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Venous procedure
About 36478: Endovenous laser ablation, first vein
Reports percutaneous laser closure of the first incompetent extremity vein treated for venous reflux, with imaging guidance and procedural monitoring included.
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.
CMS billing rules for 36478
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.17 · 18%
- Practice expense (office) RVU23.09 · 79%
- Malpractice RVU1.09 · 4%
32.1K
Medicare services in 2024 · #946 by national volume
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.
36478 compared with similar codes
Office rates for Virginia, from the same CMS release.
$1,030.48–$1,220.22
Both are first-vein endovenous ablation services, but 36478 uses laser energy and 36475 uses radiofrequency.
$1,149.08–$1,367.27
36478 uses laser thermal energy; 36473 uses a mechanochemical technique for the first vein.
$1,624.17–$1,936.61
36478 closes the vein with laser energy, whereas 36482 uses chemical adhesive for the first vein.
Compare 36478 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
$1131.03
Facility
$266.99
Virginia →
Office / nonfacility
$956.50
Facility
$235.49
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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 under the CMS facts?
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 under the listed CMS rules.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
4,48736474,,Endovenous mchnchem add-on,A,,1.71,5.11,,0.25,,0.38,7.20,2.34,0,ZZZ,0.00,0.00,0.00,0,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,48836475,,Endovenous rf 1st vein,A,,5.17,25.30,,1.06,,1.15,31.62,7.38,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,48936476,,Endovenous rf vein add-on,A,,2.58,5.20,,0.37,,0.57,8.35,3.52,0,ZZZ,0.00,0.00,0.00,0,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,49036478,,Endovenous laser 1st vein,A,,5.17,23.09,,1.13,,1.09,29.35,7.39,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,49136479,,Endovenous laser vein addon,A,,2.58,6.17,,0.45,,0.54,9.29,3.57,0,ZZZ,0.00,0.00,0.00,0,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,49236481,,Insertion of catheter vein,A,,6.56,41.76,,1.11,,0.75,49.07,8.42,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,49336482,,Endoven ther chem adhes 1st,A,,3.41,45.46,,0.59,,0.75,49.62,4.75,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00