Does 36475 require prior authorization?

No, 36475 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 36475?

Medicare facility rate: $246.50. Non-facility rate: $1056.14. Work RVU: 5.17.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

5.17

Facility

$246.50

Non-Facility

$1056.14

Claims submitted without a valid ICD-10-CM diagnosis code will be returned as incomplete; the diagnosis code must best describe the patient's condition for the service performed.
The patient's medical record must contain documentation fully supporting medical necessity including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Medical record must document history and physical findings supporting a diagnosis of symptomatic varicose veins.
Medical record must document failure of an adequate trial of conservative treatment as described in the LCD.

Interventional treatments are covered for symptomatic varicose veins of the lower extremity when the medical record documents history and physical findings supporting the diagnosis.
Coverage requires failure of an adequate trial of conservative treatment prior to interventional therapy as described in the LCD.
Coverage requires exclusion of other causes of limb edema, ulceration, and pain prior to treatment of varicose veins.
Coverage requires performance of appropriate diagnostic testing (e.g., duplex ultrasound) to confirm the presence and location of incompetent perforating veins when indicated.
Injection sclerotherapy (CPT 36468) is appropriate for treatment of symptomatic spider veins / telangiectasia of the lower extremities.
Non-compounded foam (NCF) sclerotherapy is appropriate for treatment of incompetent extremity truncal veins (report with CPT 36465 or 36466).

L34536 — Treatment of Varicose Veins of the Lower Extremities

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A56914 — Billing and Coding: Treatment of Varicose Veins of the Lower Extremities

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L33575 — Varicose Veins of the Lower Extremity, Treatment of

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A52870 — Billing and Coding: Treatment of Varicose Veins of the Lower Extremity

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Ask Verity about documentation requirements, denial risks, or coverage in your state.