The short version
- Sclerotherapy splits by agent and vein: 36465 (microfoam, single truncal vein) and 36466 (microfoam, multiple) bill the FDA-approved microfoam; 36470 (liquid, single) and 36471 (liquid, multiple non-truncal) bill liquid sclerosant.
- The reimbursement gap is enormous — microfoam truncal codes pay roughly $1,100+ while liquid codes pay around $92–$147 — so picking the code the agent and vein actually dictate is where the dollars are.
- Spider veins are cosmetic: 36468 (telangiectasia) is excluded by health plans and Medicare, no matter how it’s billed.
- Even covered liquid sclerotherapy (36470/36471) has limits — many plans cap covered sessions, often around three per leg per year, and anything beyond that reads as cosmetic.
Sclerotherapy codes: 36465/36466 microfoam vs 36470/36471 liquid
Sclerotherapy isn’t one code; it’s two families split by the agent and the vein. 36465 (single truncal vein) and 36466 (multiple, same extremity) are reserved for FDA-approved non-compounded microfoam. 36470 (single) and 36471 (multiple, non-truncal) bill liquid sclerosant. They are not interchangeable.
So the first decision is what was actually injected, into what. Microfoam into a truncal vein is the 364 65/66 family; liquid into non-truncal veins is 36470/71. Pick by the agent and the target, then read the next section, because that choice is worth an order of magnitude.
Why microfoam truncal (36465) pays roughly 10× liquid (36470)
This is the part that moves the P&L. Microfoam truncal sclerotherapy, 36465 and 36466, reimburses in the neighborhood of $1,100, reflecting the FDA-approved microfoam and the truncal target. Liquid sclerotherapy, 36470 and 36471, pays roughly $92 and $147. Same broad procedure name, a tenfold gap on the remit. Those are 2026 Medicare national averages for the ASC setting; done in-office the microfoam codes run higher still — roughly $1,290 and $1,340 — while liquid lands near $120 to $205, so the multiple barely moves. Commercial contracts vary, often at a multiple of Medicare, so check your own payer agreement on every figure here.
That gap is exactly why miscoding hurts here more than almost anywhere. Bill a microfoam truncal case as liquid and you’ve handed back 90% of the reimbursement; bill liquid as microfoam and you’ve invited a takeback. Match the code to the agent and the vein the operative note documents, every time, and capture the value the procedure actually earned.
36468 (telangiectasia) is cosmetic
One code is a coverage dead end. 36468 is sclerotherapy of telangiectasias, spider veins, and payer policy and Medicare treat it as cosmetic and exclude it. There’s no documentation that converts a true spider-vein case into a covered one.
And the covered liquid codes have a ceiling. 36470 and 36471 are generally covered up to three sessions per leg per year; beyond that, additional sessions read as cosmetic maintenance. So the discipline is two-fold: don’t bill cosmetic spider veins to insurance, and don’t run covered sclerotherapy past the session cap and expect it to keep paying.
Documenting sclerotherapy for coverage
The sclerotherapy claim that clears carries the same spine as ablation: documented venous reflux on duplex ultrasound, the symptoms, and a failed conservative trial where the payer requires it, plus the agent and vein that justify the specific code. Sclerotherapy often follows or accompanies ablation, so the necessity record frequently already exists, use it.
Track the session count per leg, match the code to the agent, and keep the spider-vein work off the insurance claim. We cover the ablation side in our vein ablation guide. Compare the Medicare allowable for each delivery code in your locality on Billing IQ before you pick the path. If sclerotherapy is underpaying or denying, our medical billing operation works the code selection and the appeals behind it.
Frequently asked questions
Is sclerotherapy covered by insurance?
When it’s medically necessary, yes. Sclerotherapy of refluxing, symptomatic veins is covered — microfoam codes 36465/36466 and liquid codes 36470/36471 — typically with documented reflux and, where required, a failed conservative trial. Sclerotherapy of spider veins (36468, telangiectasia) is cosmetic and not covered.
What’s the difference between sclerotherapy CPT codes?
36465 (single truncal) and 36466 (multiple) bill FDA-approved non-compounded microfoam; 36470 (single) and 36471 (multiple, non-truncal) bill liquid sclerosant; 36468 is spider-vein (telangiectasia) treatment and is cosmetic. The agent injected and the vein treated determine the code.
Why does microfoam sclerotherapy pay more than liquid?
Microfoam truncal sclerotherapy (36465/36466) reimburses roughly $1,100, reflecting the FDA-approved microfoam and truncal target, while liquid sclerotherapy (36470/36471) pays roughly $92–$147. Those are 2026 Medicare national averages (ASC setting); in-office the codes run higher, and commercial contracts vary, so check your own payer schedule. Miscoding a microfoam truncal case as liquid can give back most of the reimbursement.
Is spider vein treatment covered by insurance?
No. Sclerotherapy of spider veins and telangiectasias (CPT 36468) is considered cosmetic and is excluded by health plans and Medicare. No documentation converts a true spider-vein case into a covered one — it is the patient’s responsibility.
How many sclerotherapy sessions does insurance cover?
For covered liquid sclerotherapy (36470/36471), payers commonly cover up to three sessions per leg per year; sessions beyond that are generally considered cosmetic maintenance and are not covered.
This article explains how these codes tend to get paid — it is not coding, billing, or legal advice. Some of the codes here are bundled into the main procedure, or fall into grey areas that vary by payer. Before billing anything in a grey area, confirm it with your own coding and compliance team and the current guidance from the American Vein & Lymphatic Society (AVLS), Medicare (CMS), and AMA CPT. When in doubt, don’t bill it.
