ModifiedBlue Cross Blue Shield - North CarolinaPolicy N/A

Renal Denervation as a Treatment of Hypertension

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Governs BCBSNC coverage for radiofrequency and ultrasound renal denervation procedures to treat uncontrolled hypertension; states investigational stance, summarizes evidence, and lists applicable billing codes.

Policy Summary

PayerBlue Cross Blue Shield - North Carolina

PolicyRenal Denervation as a Treatment of Hypertension

Policy CodePolicy N/A

Change TypeTitle changeinvestigational stance clarifiedcoding updates added

Effective DateJul 16, 2025

Last ReviewMar 11, 2026

Next Review DateFeb 2, 2026

Key ActionDo not submit claims for renal denervation (RFA or usRDN) as these procedures are considered investigational and will be denied; be prepared to provide requested medical records if queried.

SourceLink

POLICY UPDATE CHANGES

Policy statement updated to read: 'Radiofrequency ablation and ultrasound ablation of the renal sympathetic nerves are considered investigational. BCBSNC does not provide coverage for investigational services or procedures.'

Description and Policy Guidelines updated to include information regarding ultrasound renal denervation.

Billing/Coding section updated to add code 0339T and new codes 0935T, C1735, C1736 effective 1/1/2025.

Not Covered section edited for clarity: replaced 'resistant' hypertension with 'uncontrolled' hypertension.

Investigationalcoverage stance

Nov 2023

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

ModifiedBlue Cross Blue Shield - North CarolinaPolicy N/A

Renal Denervation as a Treatment of Hypertension

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Sign up for all Blue Cross Blue Shield - North Carolina policy alerts

Know when Blue Cross Blue Shield - North Carolina releases new policies or updates existing guidance.

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Policy Summary

PayerBlue Cross Blue Shield - North Carolina

PolicyRenal Denervation as a Treatment of Hypertension

Policy CodePolicy N/A

Change TypeTitle changeinvestigational stance clarifiedcoding updates added

Effective DateJul 16, 2025

Last ReviewMar 11, 2026

Next Review DateFeb 2, 2026

Key ActionDo not submit claims for renal denervation (RFA or usRDN) as these procedures are considered investigational and will be denied; be prepared to provide requested medical records if queried.

SourceLink

POLICY UPDATE CHANGES

Description and Policy Guidelines updated to include information regarding ultrasound renal denervation.

Billing/Coding section updated to add code 0339T and new codes 0935T, C1735, C1736 effective 1/1/2025.

Not Covered section edited for clarity: replaced 'resistant' hypertension with 'uncontrolled' hypertension.

Investigationalcoverage stance

Nov 2023

0339T +3coding updates

MD reviews 4/2025 & 2/2026clinical reviews

Coverage Determination

Not covered — investigational procedures

Policy coverage determination

Overall stance: Radiofrequency ablation and ultrasound ablation of the renal sympathetic nerves are considered investigational for the treatment of uncontrolled hypertension

BCBSNC does not provide coverage for investigational services or procedures.

Not covered — investigational

Policy statement

Investigational stance: Radiofrequency ablation and ultrasound ablation of the renal sympathetic nerves are considered investigational.

BCBSNC does not provide coverage for investigational services or procedures.

There are no covered indications listed for renal denervation in this policy. Under the section "When Renal Denervation is covered" the policy states: Not applicable, indicating that BCBSNC does not recognize any circumstances under which these procedures are a covered benefit. The policy explicitly identifies the procedures as investigational in the context of treatment for hypertension.

The policy states that radiofrequency ablation and ultrasound ablation of the renal sympathetic nerves are considered investigational. As investigational procedures, renal denervation using radiofrequency or ultrasound energy is not supported as a covered therapy by BCBSNC.

Specifically, the policy designates these therapies as investigational for the treatment of uncontrolled hypertension. The Not Covered language reads: "Radiofrequency ablation and ultrasound ablation of the renal sympathetic nerves are considered investigational for the treatment of uncontrolled hypertension."

Because the procedures are characterized as investigational, BCBSNC considers radiofrequency and ultrasound renal denervation not covered / not medically necessary. The policy statement is explicit: "BCBSNC does not provide coverage for investigational services or procedures."

Billing and Code Information

Applicable service codesmixed

0338T
0339T
0935T
C1735
C1736

Billing/Coding updatesmixed

0338T	Unlisted/relevant renal denervation code previously added (per history)
0339T	Renal denervation code (added/removed at various dates per history)
0935T	New code added to Billing/Coding section effective 1/1/2025
C1735	New code added to Billing/Coding section effective 1/1/2025
C1736	New code added to Billing/Coding section effective 1/1/2025

Regulatory / FDA referenceother

P220023B

FDA Summary of Safety and Effectiveness Data – Paradise Ultrasound Renal Denervation System (document identifier)

Evidence sources — randomized sham-controlled trials and systematic reviews

Key randomized, sham-controlled trialsRADIANCE program (RADIANCE-HTN SOLO, RADIANCE II, RADIANCE-HTN TRIO) and other randomized sham-controlled trials evaluating ultrasound renal denervation and medication-titration strategies.

Comparative device trialsRADIOSOUND-HTN — a three-arm randomized trial comparing different renal denervation devices and techniques.

Large trial series and analysesSYMPLICITY series (including HTN-3 and subsequent analyses) contributing to evidence on catheter-based RDN techniques and outcomes.

Authoritative reviews and statementsAHA Scientific Statement: Renal Denervation for the Treatment of Hypertension (Cluett et al., Hypertension, Oct 2024) summarizing trial evidence and guidance.

Regulatory evidence sourceFDA Summary of Safety and Effectiveness Data (SSED) — Paradise Ultrasound Renal Denervation System (P220023B).

Provider Notices and Documentation

Prior Authorization

List applicable procedure codes; records may be requested

Applicable service codes: 0338T, 0339T, 0935T, C1735, C1736. BCBSNC may request medical records to determine medical necessity for these codes; letters of support or explanation can be useful but are not sufficient unless they include all information needed for a medical necessity determination.

Applicable service codes listed: 0338T, 0339T, 0935T, C1735, C1736
BCBSNC may request medical records for determination of medical necessity
Letters of support/explanation are useful but not sufficient unless they include all specific information needed for a medical necessity determination

Billing Rule

Billing/coding updates and investigational status

Clinical Background

Hypertension is a common chronic condition with substantial cardiovascular and renal consequences. Approximately 30% of the U.S. population is affected, and uncontrolled hypertension—defined as blood pressure that remains above targeted levels despite lifestyle modification and pharmacologic therapy—contributes to increased risk of heart disease, stroke, and progressive kidney disease. Renal denervation procedures aim to reduce sympathetic signaling by ablating renal sympathetic nerves, but the policy considers these approaches investigational and not covered pending sufficient evidence of safety and effectiveness.

Key Definitions

Uncontrolled hypertension — diagnostic/clinical thresholds and context

DefinitionUncontrolled hypertension: blood pressure remaining above targeted levels when a patient is not using, or unable to use, treatments to control blood pressure or when hypertension persists despite antihypertensive therapies.

Includes resistant hypertensionResistant hypertension is included: BP above target despite use of 3 or more antihypertensive medications, including a diuretic, with complementary mechanisms of action.

Contributing factors to uncontrolled BPNonadherence, excessive salt intake, inadequate dosing, excess alcohol, volume overload, drug-induced hypertension, secondary causes (eg, obstructive sleep apnea).

Clinical context/actionable pointOptimization of medical therapy and addressing comorbid conditions is implied prior to procedural interventions for uncontrolled hypertension.

Renal denervation (RFA/usRDN) — procedural definition

Policy Summary

PayerBlue Cross Blue Shield - North Carolina

PolicyRenal Denervation as a Treatment of Hypertension

Policy CodePolicy N/A

Change TypeTitle changeinvestigational stance clarifiedcoding updates added

Effective DateJul 16, 2025

Last ReviewMar 11, 2026

Next Review DateFeb 2, 2026

Key ActionDo not submit claims for renal denervation (RFA or usRDN) as these procedures are considered investigational and will be denied; be prepared to provide requested medical records if queried.

SourceLink

On This Page

Billing/Coding section includes CPT/HCPCS codes 0338T, 0339T, 0935T, C1735, C1736; the policy states these procedures are investigational and are not covered.

Billing/Coding updates added code 0339T and new codes 0935T, C1735, C1736 (effective 1/1/2025)
Inclusion of codes in policy does not imply reimbursement; policy stance: procedures are investigational and not covered

Step Therapy

Confirm uncontrolled hypertension after optimized medical therapy

Uncontrolled hypertension is defined as blood pressure remaining above targeted levels despite antihypertensive therapies, including resistant hypertension (BP above target despite 3+ antihypertensive medications, including a diuretic); the policy context emphasizes optimization of medical therapy prior to procedural therapies.

Uncontrolled hypertension includes resistant hypertension (use of 3 or more antihypertensive medications, including a diuretic)
Ensure lifestyle modification and optimization of antihypertensive therapy before considering procedural interventions

Documentation Required

Provide complete clinical documentation on submission

Document clinical rationale fully when submitting requests for renal denervation–related procedures; include complete medical records and all information needed to determine medical necessity since procedural codes are listed but are considered investigational by BCBSNC.

Provide full medical records when requested
Include documentation of prior medical therapy and evidence of uncontrolled hypertension

Documentation Required

Medical records may be requested for medical necessity review

BCBSNC may request medical records to determine medical necessity for renal denervation procedures; letters of support alone are not sufficient unless they contain all required information.

Medical records may be requested to verify medical necessity
Letters of support/explanation should accompany but cannot replace complete records

Note

Policy history and documentation notes for providers

Policy history documents prior coding changes, additions, and reviews (including additions of 0338T/0339T and codes added 12/31/24); there are no additional explicit provider documentation requirements listed beyond the medical-records request language.

Policy implementation history records code additions and removals (e.g., 0338T/0339T, and 0935T/C1735/C1736 added effective 1/1/2025)
No new explicit provider documentation requirements beyond standard medical-record requests are specified

Denial Risk

Investigational — risk of claim denial

Claims for radiofrequency ablation or ultrasound ablation of the renal sympathetic nerves for treatment of uncontrolled hypertension are at risk of denial because BCBSNC considers these procedures investigational and does not provide coverage for investigational services.

Procedures are considered investigational and not covered by BCBSNC
Submit complete records if requesting review, but anticipate denial consistent with policy stance

Denial Risk

Investigational — procedures will be denied

Procedures for renal denervation (radiofrequency or ultrasound ablation of the renal sympathetic nerves) will be denied as investigational services or procedures under this policy.

BCBSNC policy statement: 'Radiofrequency ablation and ultrasound ablation of the renal sympathetic nerves are considered investigational.'
BCBSNC does not provide coverage for investigational services or procedures

Procedure typeMinimally invasive, percutaneous, catheter-based renal denervation performed via femoral arterial access to deliver energy to the renal artery wall and ablate renal sympathetic nerves.

Radiofrequency renal denervation (RFA)A flexible catheter is advanced into the renal artery and controlled low‑power RF energy is delivered to arterial walls to ablate sympathetic nerves, decreasing afferent and efferent renal sympathetic signaling.

Ultrasound renal denervation (usRDN)A catheter with an inflatable balloon is positioned in the renal artery; cooling fluid is used and 2–3 ultrasound emissions are delivered per renal artery to disrupt renal sympathetic nerves; can treat main and accessory renal arteries.

Physiological aimBoth RFA and usRDN aim to reduce sympathetic activation, decrease vasoconstriction, and inhibit the renin‑angiotensin system to lower blood pressure.

Ablation description — endovascular ablation of renal sympathetic nerves

Ablation target and approachEndovascular ablation targets renal sympathetic nerves located in or near the renal artery wall and is performed via percutaneous femoral arterial access using catheter-delivered energy.

Energy modalitiesEnergy modalities include radiofrequency energy (delivered via catheter electrodes) or ultrasound energy (delivered via an intravascular balloon catheter).

Typical technical details — RFARFA uses controlled low‑power RF energy delivered to arterial walls through a flexible catheter; catheter is removed after adequate ablation.

Typical technical details — usRDNusRDN involves balloon inflation with cooling fluid and delivery of 2–3 ultrasound emissions per renal artery; can treat accessory renal arteries when present.

Intended effectAblation reduces both afferent and efferent sympathetic signaling between kidneys and brain to lower blood pressure.