ModifiedBlue Cross Blue Shield - North CarolinaPolicy N/A

Renal Denervation as a Treatment of Hypertension

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This policy describes Blue Cross Blue Shield of North Carolina's coverage stance and clinical evidence assessment for radiofrequency and ultrasound renal denervation as treatments for uncontrolled or resistant hypertension; it applies to BCBSNC providers and members.

Policy Summary

PayerBlue Cross Blue Shield - North Carolina

PolicyRenal Denervation as a Treatment of Hypertension

Policy CodePolicy N/A

Change TypeMaterial revision — investigational stance updatedcoding additions

Effective DateJul 16, 2025

Last ReviewMar 11, 2026

Next Review DateJun 1, 2026

Key ActionReview member benefits and expect investigational-denial risk; submit medical records if requested to support medical necessity determinations.

SourceLink

POLICY UPDATE CHANGES

Policy statement updated to: '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 updated to read: 'Radiofrequency ablation and ultrasound ablation of the renal sympathetic nerves are considered investigational for the treatment of uncontrolled hypertension.'

Billing/Coding section had codes 0339T, 0935T, C1735, C1736 added effective 1/1/2025 (0339T previously removed in 2019 then re-added).

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ModifiedBlue Cross Blue Shield - North CarolinaPolicy N/A

Renal Denervation as a Treatment of Hypertension

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Policy Summary

PayerBlue Cross Blue Shield - North Carolina

PolicyRenal Denervation as a Treatment of Hypertension

Policy CodePolicy N/A

Change TypeMaterial revision — investigational stance updatedcoding additions

Effective DateJul 16, 2025

Last ReviewMar 11, 2026

Next Review DateJun 1, 2026

Key ActionReview member benefits and expect investigational-denial risk; submit medical records if requested to support medical necessity determinations.

SourceLink

POLICY UPDATE CHANGES

Not Covered section updated to read: 'Radiofrequency ablation and ultrasound ablation of the renal sympathetic nerves are considered investigational for the treatment of uncontrolled hypertension.'

Billing/Coding section had codes 0339T, 0935T, C1735, C1736 added effective 1/1/2025 (0339T previously removed in 2019 then re-added).

InvestigationalCoverage stance

FDA-approvedFDA devices

MultipleRCTs cited

ListedService codes

2025-07-16Effective

Coverage Determination

Not covered — investigational services

Coverage determination

Not covered — investigational: 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 / Investigational — policy statement and coverage stance

Policy statement / coverage stance

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

BCBSNC does not provide coverage for investigational services or procedures.

Not applicable.

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

Radiofrequency ablation and ultrasound ablation of the renal sympathetic nerves are considered investigational and therefore not medically necessary for the treatment of uncontrolled hypertension per this policy.

The procedures described—endovascular catheter-based ablation using radiofrequency or ultrasound energy applied to the renal artery to disrupt renal sympathetic nerves—are classified as investigational and are therefore excluded from coverage and not medically necessary under this policy.

Billing and Procedure Codes

Applicable service codesmixed

0338T	Applicable service code listed in policy
0339T	Applicable service code listed in policy
0935T	Applicable service code listed in policy
C1735	Applicable HCPCS code listed in policy
C1736	Applicable HCPCS code listed in policy

Procedure codes related to renal denervationCPT | HCPCS

0338T	Unlisted in-chapter CPT (renal denervation) — as listed in prior changes (document lists addition of 0338T earlier)
0339T	Renal denervation code (removed 10/1/19, re-added 12/31/24)
0935T	New code added 1/1/2025 (document notes addition)
C1735	New code added 1/1/2025 (document notes addition)
C1736	New code added 1/1/2025 (document notes addition)

Provider Responsibilities and Prior Authorization

Note

Codes potentially subject to review

Applicable service codes are listed in the Billing/Coding section; inclusion of a code does not guarantee that it will be reimbursed. BCBSNC may request medical records to determine medical necessity for these codes.

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

Prior Authorization

Billing/Coding and prior authorization

Codes for renal denervation procedures are listed in the Billing/Coding section; because radiofrequency and ultrasound renal denervation are classified as investigational, these procedure codes would not be covered/authorized for coverage.

See Billing/Coding: 0338T, 0339T, 0935T, C1735, C1736
Investigational policy statement: investigational services are not covered

Clinical and Policy Background

Hypertension affects a large portion of the U.S. population and uncontrolled or resistant hypertension is associated with substantial morbidity. Renal sympathetic nerves contribute to blood pressure control; catheter-based renal denervation (percutaneous, femoral arterial access delivery of radiofrequency or ultrasound energy to the renal artery wall) is intended to ablate afferent and efferent renal sympathetic fibers to lower blood pressure. Despite randomized trials of renal denervation technologies, this policy classifies radiofrequency and ultrasound renal denervation as investigational for treatment of uncontrolled hypertension, and thus not covered.

Key Definitions

Uncontrolled hypertension / Resistant hypertension — definitions

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.

Resistant hypertension (within uncontrolled hypertension)Persistent elevated blood pressure despite use of 3 or more antihypertensive medications, including a diuretic, with complementary mechanisms of action.

Contributing factorsNonadherence, excessive salt intake, inadequate medication doses, excess alcohol, volume overload, drug-induced or secondary hypertension, and unaddressed comorbidities (eg, obstructive sleep apnea).

Renal denervation (RFA and usRDN) — procedure description

General descriptionMinimally invasive, percutaneous catheter-based procedures that ablate renal sympathetic nerves to reduce sympathetic signaling and lower blood pressure.

Policy Summary

PayerBlue Cross Blue Shield - North Carolina

PolicyRenal Denervation as a Treatment of Hypertension

Policy CodePolicy N/A

Change TypeMaterial revision — investigational stance updatedcoding additions

Effective DateJul 16, 2025

Last ReviewMar 11, 2026

Next Review DateJun 1, 2026

Key ActionReview member benefits and expect investigational-denial risk; submit medical records if requested to support medical necessity determinations.

SourceLink

On This Page

Note

Benefits application — check member benefit language

Review the member's benefit booklet and plan language before applying this medical policy; member benefits may vary by benefit design and this policy applies only to the services described herein.

This medical policy relates only to the services or supplies described herein; member benefit language should be reviewed.

Step Therapy

Step therapy — none specified

No step therapy requirements for renal denervation are specified in this policy's sections.

Policy Implementation and Scientific Background sections do not specify step therapy requirements.

Documentation Required

Medical records may be requested

BCBSNC may request medical records to determine medical necessity. When records are requested, letters of support or explanation can be useful but are not sufficient unless all specific information needed to make a medical necessity determination is included.

BCBSNC may request medical records for determination of medical necessity.
Letters of support/explanation are often useful but insufficient alone unless all required information is provided.

Documentation Required

Documentation supporting noncoverage

The Not Covered section and policy statement classify radiofrequency and ultrasound renal denervation as investigational; documentation that these procedures are investigational will support noncoverage determinations.

Not Covered: radiofrequency and ultrasound ablation of the renal sympathetic nerves are investigational for treatment of uncontrolled hypertension.
Policy statement: investigational services/procedures are not covered by BCBSNC.

Denial Risk

Investigational services denial — procedures not covered

Radiofrequency ablation and ultrasound ablation of the renal sympathetic nerves are considered investigational; services determined investigational are not covered and may be denied.

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.”
Not Covered section: investigational for treatment of uncontrolled hypertension.

Denial Risk

Investigational — denial risk for RFA and usRDN

Procedures considered investigational (radiofrequency and ultrasound renal denervation) are not covered and will be denied as investigational if submitted for coverage.

Policy implementation update: policy statement updated that these procedures are investigational and BCBSNC does not provide coverage.
Not Covered: investigational for treatment of uncontrolled hypertension.

Radiofrequency renal denervation (RFA)Performed percutaneously via femoral artery access; a flexible catheter is advanced to the renal artery and controlled low‑power radiofrequency energy is delivered to the arterial wall to ablate renal sympathetic nerves; catheter removed after adequate energy delivery.

Ultrasound renal denervation (usRDN)Percutaneous femoral arterial access with catheter advanced to the renal artery under fluoroscopy; a balloon is inflated with cooling fluid and 2–3 ultrasound emissions are delivered per renal artery to ablate sympathetic nerves; can treat main and accessory renal arteries; typically done under local anesthesia with conscious sedation.

Renal denervation — summary (endovascular catheter‑based ablation)

Modality summaryEndovascular catheter-based ablation (radiofrequency or ultrasound) of renal sympathetic nerves intended to decrease afferent and efferent renal sympathetic signaling, reduce vasoconstriction, and inhibit the renin–angiotensin system to lower blood pressure.

Access and techniqueProcedures are performed percutaneously via femoral arterial access with device-specific energy delivery to the renal artery wall (RF energy or ultrasound emissions delivered via an intravascular catheter/balloon).

Treatment targetsAblation targets renal sympathetic nerves located in the arterial wall of the renal arteries; devices and techniques vary by system and may treat main and accessory renal arteries.

Evidence contextStudied in multiple randomized, sham‑controlled and follow‑up trials (eg, RADIANCE, RADIOSOUND, SPYRAL) and referenced in recent scientific reviews and FDA device summaries.