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36476

PAYER POLICY CHANGES

36476 Insurance Policy Changes

CPT 36476, in plain terms, covers Using radiofrequency heat to seal an additional problematic vein during the same treatment session. CPT 36476 is referenced in 9 tracked payer policy changes from Independence Blue Cross, Health Net, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 36476 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 36476 on AAPC

Independence Blue Cross · Effective Jan 1, 2026High impact
MA11.001l, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Independence Blue Cross Medicare Advantage updated policy MA11.001l effective 01/01/2026 to expand coverage of varicose vein treatments. Key changes include: CPT 36468 reclassified from cosmetic to medically necessary, CPT 36482 and 36483 upgraded from experimental/investigational to medically necessary, HCPCS S2202 (Echosclerotherapy) now covered, new CPT 37799 added for stab phlebectomy with fewer than 10 incisions, and CPT 37500 deleted. Additional coverage added for bulbous varicosities, venous malformations, and telangiectasia with hemorrhage.
Independence Blue Cross · Effective Jan 1, 2026High impact
MA11.001l, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Independence Blue Cross Medicare Advantage reissued policy MA11.001l effective 01/01/2026 with expanded coverage for varicose vein treatments. Key changes include: sclerotherapy and cyanoacrylate adhesive now covered for saphenous veins; CPT 36468 reclassified from cosmetic to medically necessary; CPT 36482 and 36483 upgraded from experimental/investigational to medically necessary; S2202 echosclerotherapy upgraded to medically necessary; CPT 37500 deleted; and CPT 37799 added for stab phlebectomy with fewer than 10 incisions.
Health Net · Effective Dec 1, 2025High impact
25-998 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency
Health Net California is updating prior authorization requirements effective December 1, 2025, removing PA requirements for some services while adding requirements for others. Key changes include removing PA requirements for ABA therapy, physical therapy, and genetic testing while maintaining PA requirements for TMS, certain surgeries, and specific pharmaceuticals.
Independence Blue Cross · Effective Jul 28, 2025High impact
MA11.001k, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Independence Blue Cross updated MA policy MA11.001k to MA11.001l effective 07/28/2025, clarifying TIPP terminology, revising the Venous Clinical Severity Score (VCSS) threshold for saphenous vein treatment from less than 6 to greater than 6, adding CPT 37799 for endovenous cryoablation, and removing experimental/investigational language for certain perforator vein procedures. These changes affect coverage criteria and billing for varicose vein treatments.
Excellus BlueCross BlueShield · Effective Oct 22, 2026Medium impact
Varicose Vein Treatments 7.01.47
Endovenous laser ablation, radiofrequency ablation, polidocanol 1% microfoam (Varithena) and cyanoacrylate adhesive ablation (VenaSeal) are considered medically appropriate for symptomatic varicose veins or venous insufficiency when all of these are met: saphenous reflux of at least 500 milliseconds documented by duplex ultrasound, CEAP class C2 or greater, and a documented indication of ulceration from venous stasis, recurrent superficial thrombophlebitis, hemorrhage from a ruptured superficial varicosity, or persistent symptoms that significantly interfere with activities of daily living after compression therapy and activity modification for at least 3 months have not improved them. Phlebectomy, sclerotherapy and transilluminated powered phlebectomy (TPP/TIPP) are considered medically appropriate for symptomatic varicose tributaries when performed concurrently with or following prior treatment of the saphenous veins. Sclerotherapy and transcutaneous laser ablation of small diameter veins (spider veins or telangiectasia), and any treatment of asymptomatic varicose veins, are considered not medically necessary, while balloon catheter-assisted sclerotherapy, cryoablation, coil embolization, mechanochemical or endomechanical ablation (e.g., ClariVein), photothermal sclerosis (intense pulsed light), and sclerotherapy techniques other than microfoam for great, small or accessory saphenous veins are considered investigational.
Regence BlueShield · Effective Oct 1, 2026Medium impact
Varicose Vein Treatment
Varicose vein treatment is medically necessary only when the policy criteria are met, and member contract language takes precedence for eligibility. Treatment requires one of five qualifying indications and a complete venous imaging study of the superficial veins that records vein diameter and reflux in seconds at multiple levels in the thigh and calf. The qualifying indications are functional impairment of instrumental activities of daily living after at least three months of medically supervised compression therapy, recurrent superficial thrombophlebitis documented by venous imaging, recurrent or persistent hemorrhage from a ruptured varix, CEAP C4 skin and subcutaneous changes, or ulceration from venous stasis where incompetent varices are a significant contributing factor. Endovenous radiofrequency, laser or glue ablation of the great or small saphenous veins requires a vein diameter of 5.5 mm or greater for the great saphenous vein or 4 mm or greater for the small saphenous vein, reflux exceeding 0.5 seconds, and treatment of all incompetent segments of the same vein in the same session with the same modality. Cryoablation, mechanochemical, microwave, steam and high-intensity focused ultrasound ablation of any vein are investigational, as is radiofrequency, glue or laser ablation of veins other than the great or small saphenous veins. Sclerotherapy of superficial veins less than 4 mm in diameter, including reticular veins and telangiectasias, is cosmetic.
Aetna · Identified Aug 12, 2026Medium impact
Varicose Veins (CPB 0050, reviewed 2026-08-03)
Aetna considers ligation, stripping, radiofrequency, endovenous laser and cyanoacrylate closure of the saphenous veins medically necessary when incompetence at the saphenofemoral or saphenopopliteal junction is documented by ultrasound performed within the past 6 months, with junctional reflux of 500 milliseconds or greater, a vein at least 4.5 mm in diameter below the junction, and the symptom criteria in the policy are met. Liquid or foam sclerotherapy (for example Varithena) is medically necessary for symptomatic saphenous veins, varicose tributaries, accessory veins and perforator veins that are 2.5 mm or greater in diameter when the criteria are met, and ambulatory phlebectomy is medically necessary as adjunctive treatment under the same size and symptom criteria. Treatment of veins less than 2.5 mm is considered cosmetic, endovenous ablation of varicose tributaries and accessory veins other than the accessory saphenous vein is considered experimental, investigational or unproven, and sclerotherapy for reflux at the saphenofemoral or saphenopopliteal junction is considered experimental.
Michigan Medicaid - MDHHS · Identified Jun 20, 2026Medium impact
MSA 18-01
Michigan Medicaid updated coverage for CPT and HCPCS codes for physicians, clinics and other providers, with different dates for each topic. Prior authorization was required for listed codes for dates of service on and after September 1, 2017 (V5030, V5040, V5120) and January 1, 2018 (36475, 36476, 36478, 36479, 81222, 81223, 81228, 81229, 81242, 81315, 81316, 81332, 88235). Codes discontinued effective December 31, 2017 were removed, and D1354 required tooth numbers in the claim comments from January 1, 2018.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Treatment of Varicose Veins/Venous Insufficiency
Blue Cross Blue Shield Association policy 7.01.124 (BCBSMS policy A.7.01.124) states that treatment of great or small saphenous veins, accessory saphenous veins, varicose tributaries, and perforator veins may be considered medically necessary for symptomatic varicose veins or venous insufficiency when specific criteria are met, and that saphenous vein treatment not meeting those criteria is considered cosmetic and investigational. The policy history shows an update dated 09/22/2026 that changed the policy description, made minor changes to the statements for great or small saphenous veins, accessory saphenous veins, and perforator veins, and re-worded the concurrent treatment statements for accessory saphenous veins and symptomatic varicose tributaries for clarity. Telangiectasia treatment is considered cosmetic and investigational.

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REFERENCE DATA

Payers with rules16

Payers requiring prior auth16

Aetna · Effective November 1, 2026
Prior authorization required
Participating provider precertification list for Aetna
Anthem BCBS · Effective November 1, 2026
Prior authorization required
Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)
Blue Shield of California · Effective November 1, 2026
Prior authorization required
Prior Authorization List for Blue Shield Medicare

FREQUENTLY ASKED QUESTIONS

Does Aetna require prior authorization for 36476?

Aetna lists 36476 on Participating provider precertification list for Aetna for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Ambetter require prior authorization for 36476?

Ambetter lists 36476 on Ambetter Health of Delaware CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for 36476?

AmeriHealth Caritas lists 36476 on AmeriHealth Caritas Louisiana Act 233 prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 36476?

Anthem BCBS lists 36476 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for 36476?

Arizona Complete Health lists 36476 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 36476?

There are 9 tracked policy changes affecting CPT 36476, including updates from Independence Blue Cross, Health Net, Excellus BlueCross BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 36476?

Payers that have issued tracked updates for CPT 36476 include: Independence Blue Cross, Health Net, Excellus BlueCross BlueShield, Regence BlueShield, Aetna, Michigan Medicaid - MDHHS, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 36476 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 36476. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 36476?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 36476 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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MA11.001l, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence

MA11.001l, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence

25-998 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency

MA11.001k, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence

Varicose Vein Treatments 7.01.47

Varicose Vein Treatment

Varicose Veins (CPB 0050, reviewed 2026-08-03)

MSA 18-01

Treatment of Varicose Veins/Venous Insufficiency

Prior authorization required

Prior authorization required

Prior authorization required

Does Aetna require prior authorization for 36476?

Does Ambetter require prior authorization for 36476?

Does AmeriHealth Caritas require prior authorization for 36476?

Does Anthem BCBS require prior authorization for 36476?

Does Arizona Complete Health require prior authorization for 36476?

What insurance policy changes affect CPT 36476?

Which payers have updated policy for CPT 36476?

How do I get notified when CPT 36476 policy changes?

Why do payers change policies for CPT 36476?