ModifiedBlue Cross Blue Shield - North CarolinaPolicy N/A

Renal Denervation as a Treatment of Hypertension

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This policy defines Blue Cross Blue Shield of North Carolina's coverage stance and evidence summary for radiofrequency and ultrasound renal denervation procedures used to treat uncontrolled or resistant hypertension; it applies to providers submitting claims for these services for BCBSNC members.

Policy Summary

PayerBlue Cross Blue Shield - North Carolina

PolicyRenal Denervation as a Treatment of Hypertension

Policy CodePolicy N/A

Change TypeRevisedadded coding updatesclarified terminology

Effective DateJul 16, 2025

Last ReviewMar 11, 2026

Next Review DateFeb 2, 2026

Key ActionVerify member benefits and expect potential claim review or denial because radiofrequency and ultrasound renal denervation are listed as investigational and not covered.

SourceLink

POLICY UPDATE CHANGES

Policy statement updated to state that radiofrequency ablation and ultrasound ablation of the renal sympathetic nerves are considered investigational and BCBSNC does not provide coverage for investigational services or procedures.

Ultrasound renal denervation information added to Description and Policy Guidelines sections.

Billing/Coding section updated with codes 0339T, 0935T, C1735, C1736 (effective 1/1/2025).

Not Covered section language edited for clarity, replacing term 'resistant' hypertension with 'uncontrolled' hypertension.

InvestigationalPolicy stance

Nov 2023

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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 TypeRevisedadded coding updatesclarified terminology

Effective DateJul 16, 2025

Last ReviewMar 11, 2026

Next Review DateFeb 2, 2026

Key ActionVerify member benefits and expect potential claim review or denial because radiofrequency and ultrasound renal denervation are listed as investigational and not covered.

SourceLink

POLICY UPDATE CHANGES

Ultrasound renal denervation information added to Description and Policy Guidelines sections.

Billing/Coding section updated with codes 0339T, 0935T, C1735, C1736 (effective 1/1/2025).

Not Covered section language edited for clarity, replacing term 'resistant' hypertension with 'uncontrolled' hypertension.

InvestigationalPolicy stance

Nov 2023

SPYRAL & othersRFA evidence

0338T,0339T,0935T,C1735,C1736Codes noted

Coverage Determination and Criteria

Coverage determination

Covered when ALL of the following are met:

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

BCBSNC does not provide coverage for investigational services or procedures.

Not Covered — Renal denervation

Not covered

Investigational procedures: 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.

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

The Not Covered section has been updated. Radiofrequency ablation and ultrasound ablation of the renal sympathetic nerves are considered investigational for the treatment of uncontrolled hypertension. As investigational procedures, these services are not covered by BCBSNC.

Radiofrequency renal denervation (RFA) and endovascular ultrasound renal denervation (usRDN) are designated investigational by BCBSNC and therefore are not supported for coverage under this policy. Providers should expect claims for these procedures to be evaluated against this investigational stance.

For patients with uncontrolled hypertension, the policy specifies that radiofrequency and ultrasound renal denervation procedures are investigational and therefore not medically necessary per BCBSNC policy language. Claims for management of uncontrolled hypertension using these procedures are subject to denial.

Billing and Procedure Codes

Applicable service codesmixed

0338T
0339T
0935T
C1735
C1736

Billing/Coding — procedure codes mentionedCPT | HCPCS

0338T	Procedure code listed in Billing/Coding section
0339T	Procedure code added/removed in historical updates; present in current Billing/Coding updates
0935T	New procedure code added effective 1/1/2025
C1735	New HCPCS code added effective 1/1/2025
C1736	New HCPCS code added effective 1/1/2025

Provider Responsibilities, Prior Authorization, and Documentation

Prior Authorization

Prior authorization / coding note

Inclusion of codes in the Billing/Coding section indicates these service codes may be used for billing; BCBSNC may request medical records to determine medical necessity prior to payment.

Applicable service codes listed: 0338T, 0339T, 0935T, C1735, C1736

Billing Rule

Coding updates — review for coverage

Billing/Coding was updated to add procedure and HCPCS codes; claims submitted with these codes may be reviewed against the investigational policy when determining coverage.

Codes present in Billing/Coding: 0338T, 0339T, 0935T, C1735, C1736

Clinical Background and Scope

Hypertension remains a common chronic condition; this policy, retitled Renal Denervation as a Treatment of Hypertension (notification 5/14/25; effective 7/16/25), clarifies BCBSNC's position on device-based renal sympathetic nerve ablation. The policy statement and Not Covered language were revised to replace earlier terminology with uncontrolled hypertension and to include ultrasound renal denervation in the Description and Policy Guidelines sections. Specialty-matched advisory and Medical Director reviews were completed in 4/2025 and updated in 2/2026.

Key Definitions

Uncontrolled hypertension / Resistant hypertension — definition

DefinitionUncontrolled hypertension: blood pressure that remains 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 in this definition: BP remaining above target despite use of 3 or more antihypertensive medications, including a diuretic, with complementary mechanisms of action.

Common contributing factorsNonadherence, excessive salt intake, inadequate medication doses, excess alcohol, volume overload, drug-induced hypertension, and secondary hypertension; address comorbidities (eg, obstructive sleep apnea) when present.

Policy applicationThe policy uses this definition to characterize the population considered for renal denervation; the term 'uncontrolled' replaces earlier use of 'resistant' in policy language.

Renal denervation (RFA and usRDN) — procedure description

Policy Summary

PayerBlue Cross Blue Shield - North Carolina

PolicyRenal Denervation as a Treatment of Hypertension

Policy CodePolicy N/A

Change TypeRevisedadded coding updatesclarified terminology

Effective DateJul 16, 2025

Last ReviewMar 11, 2026

Next Review DateFeb 2, 2026

Key ActionVerify member benefits and expect potential claim review or denial because radiofrequency and ultrasound renal denervation are listed as investigational and not covered.

SourceLink

On This Page

0339T was re-added 12/31/24; 0935T, C1735, C1736 effective 1/1/2025

Note

Benefit verification recommended

Verify the member's benefits before submitting a claim; this medical policy applies only to the services described and member benefits may vary by plan.

Review the Member's Benefit Booklet for availability of benefits
Member benefit language should be reviewed before applying this medical policy

Step Therapy

Step therapy requirements

No step therapy requirements are specified in the policy sections provided.

Documentation Required

Medical records may be requested

BCBSNC may request medical records for determination of medical necessity; letters of support or explanation may be useful but are not sufficient unless all required information is included.

Provide complete medical records when requested to support medical necessity determinations
Letters of support alone are insufficient unless they include all specific information needed

Documentation Required

Documentation notes

Document the investigational status in the medical record and record the procedural codes listed in the Billing/Coding section when filing claims.

Policy statement: procedures are investigational and not covered by BCBSNC
Include applicable service codes 0338T, 0339T, 0935T, C1735, C1736 in billing records as appropriate

Denial Risk

Denial risk — investigational procedures

Claims for radiofrequency or ultrasound renal denervation for treatment of uncontrolled hypertension may be denied because the policy states these procedures are investigational.

Policy: “Radiofrequency ablation and ultrasound ablation of the renal sympathetic nerves are considered investigational. BCBSNC does not provide coverage for investigational services or procedures.”
Not Covered section: procedures considered investigational for treatment of uncontrolled hypertension

Denial Risk

Investigational — not covered (do not expect coverage)

Radiofrequency and ultrasound ablation of the renal sympathetic nerves are considered investigational and are listed as Not Covered; claims for these services risk denial and are not covered by BCBSNC.

Policy statement updated: investigational and not covered for treatment of uncontrolled hypertension
Not Covered section explicitly lists radiofrequency and ultrasound renal denervation as investigational

Procedure typesRenal denervation performed by catheter-based radiofrequency ablation (RFA) or endovascular ultrasound (usRDN).

MechanismAblation disrupts renal sympathetic nerves to decrease afferent and efferent sympathetic signaling, reducing sympathetic activation, vasoconstriction, and renin–angiotensin system activation to lower blood pressure.

Access and approachPerformed percutaneously via femoral artery access with a catheter advanced into the renal artery under fluoroscopic guidance; RFA delivers controlled low‑power RF energy to renal arterial walls; usRDN uses an intravascular balloon with cooling fluid to deliver 2–3 ultrasound emissions per renal artery.

Anesthesia/sedationusRDN is typically performed under local anesthesia with conscious sedation; RFA description notes percutaneous catheter technique (local anesthesia implied).

'uncontrolled hypertension' terminology used in policy

Terminology changePolicy language was edited to use 'uncontrolled' hypertension in place of earlier 'resistant' hypertension when describing the population assessed for renal denervation.

Scope of 'uncontrolled''Uncontrolled' is used as an inclusive term encompassing resistant hypertension but exact clinical BP thresholds are not provided in the policy text.

Implication for coverage languageNot Covered and investigational statements reference treatment of 'uncontrolled' hypertension for radiofrequency and ultrasound renal denervation.