Procedures in Office Settings
Endovenous Ablation for Chronic Venous Insufficiency
A minimally invasive, office-based treatment that closes diseased veins, restores healthy circulation, relieves symptoms, promotes healing of venous leg ulcers, and helps prevent recurrence—all at nearly one-third the cost of hospital outpatient care.
3x
more costly in a hospital outpatient department vs. office-based setting
Faster
ulcer healing with early endovenous ablation vs. delayed treatment
Understanding Chronic Venous Insufficiency
Chronic Venous Insufficiency (CVI) occurs when the valves in the leg veins become damaged or weakened, allowing blood to flow backward and pool in the lower extremities. Over time, increased venous pressure leads to progressively worsening symptoms, skin changes, and, in advanced cases, venous leg ulcers.
Patients may experience aching, heaviness, burning, itching, leg fatigue, varicose veins, swelling, skin discoloration, and ultimately venous ulcers. Treating the underlying venous insufficiency before ulcers develop can relieve symptoms, improve quality of life, and help prevent disease progression.
Treating the root cause — not just the wound. Endovenous ablation closes the diseased vein so blood is redirected through healthy veins. Modern thermal and non-thermal techniques improve circulation, reduce swelling, promote ulcer healing, and help prevent recurrence through a minimally invasive procedure that is well suited to the office-based setting.
Who May Benefit from Endovenous Ablation
Patients with chronic venous insufficiency often experience symptoms that interfere with daily activities and quality of life.
Varicose veins • Leg aching • Heaviness • Burning or itching • Leg fatigue • Swelling • Skin discoloration • Venous leg ulcers
Key Benefits of Office-Based Treatment
Minimally Invasive
Performed through a small catheter without open surgery or general anesthesia.
Minimal Downtime
Most patients return quickly to normal activities with little discomfort.
Treats the Root Cause
Closes the diseased vein to improve circulation, relieve symptoms, promote ulcer healing, and reduce recurrence.
Lower Cost
Medicare pays substantially more when the same procedure is performed in a hospital outpatient department.
Modern Treatment Options
Office-based physicians use several proven technologies to treat chronic venous insufficiency.
Thermal Ablation
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Radiofrequency Ablation (RFA)
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Endovenous Laser Ablation (EVLA)
Non-Thermal Ablation
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Polidocanol Injectable Foam (Varithena®)
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Cyanoacrylate Adhesive Closure (VenaSeal™)
While the technologies differ, they share the same goal: closing the diseased vein so blood can be redirected through healthy veins.
Research & Clinical Outcomes
A landmark randomized controlled trial demonstrated that early endovenous ablation leads to faster venous ulcer healing and more time free from ulcers than delayed treatment.
Published in the New England Journal of Medicine, the EVRA Trial (Gohel et al., 2018) showed that patients receiving early endovenous ablation healed faster and remained ulcer-free longer than those receiving deferred treatment. The findings support treating the underlying venous insufficiency early rather than relying on wound care alone.
Cost & Access
Medicare pays nearly three times more for CPT 36475 when performed in a hospital outpatient department than in a physician office. In the 2023 national fee schedules, average reimbursement was approximately $1,100 in the office compared with $3,254 in the hospital outpatient department. Higher spending does not produce better clinical outcomes, making office-based care a high-value option for patients and Medicare.
Racial Disparities in Venous Disease Presentation and Care
Research suggests Black patients are more likely to present with advanced chronic venous insufficiency at younger ages and are at greater risk for serious complications. Earlier diagnosis and timely access to office-based treatment can help reduce these disparities by making effective care available before disease progresses.
Why Office-Based Access Matters
Earlier treatment improves outcomes. Office-based vascular practices expand access to timely, high-quality care while reducing Medicare spending and helping patients avoid unnecessary delays.
Protecting reimbursement for office-based endovenous procedures supports patient access, encourages earlier intervention, and helps preserve high-value vascular care in communities across the country.
Black patients present with more advanced venous disease at younger ages. Earlier access to office-based RFA is a key strategy for closing this gap before serious complications occur.
Venous Ablation Providers
