C1736, Catheter(s), intravascular for renal denervation, ultrasound, including all
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Procedure should only be performed in experienced, specialized centers with multidisciplinary hypertension teams and after shared decision-making about risks and benefits.
- Procedure codes listed are for reference only and may not be all-inclusive; coverage determinations must be based on the written policy position and review of the member's benefit contract or SPD for exclusions and limitations.
Key Coverage Criteria
- Indication: Medically necessary for uncontrolled hypertension defined as blood pressure >130/80 mmHg despite use of 3 or more antihypertensive medications from 3 classes at maximally tolerated doses, or in cases of intolerance to antihypertensive meds with BP uncontrolled despite lifestyle changes; RF denervation of renal sympathetic nerves (RFA) or ultrasound denervation (usRDN) may be considered medically necessary.
- Indication: Renal denervation (RF or ultrasound) is medically necessary when blood pressure remains >130/80 mmHg despite 3+ antihypertensive meds from 3 classes at maximally tolerated doses, or in individuals intolerant to antihypertensives with uncontrolled BP despite lifestyle modifications.
- Radiofrequency ablation may be considered medically necessary for individuals whose blood pressure remains above >130/80 mmHg despite use of 3 or more antihypertensive medications from 3 classes at maximally tolerated doses; or for individuals intolerant to antihypertensive medications whose blood pressure remains uncontrolled despite attempting lifestyle modifications.
- Ultrasound ablation may be considered medically necessary for individuals whose blood pressure remains above >130/80 mmHg despite use of 3 or more antihypertensive medications from 3 classes at maximally tolerated doses.
- Renal denervation may be considered for individuals with intolerance to antihypertensive medications whose blood pressure remains uncontrolled despite attempting lifestyle modifications.
- Priority may be given to patients with higher cardiovascular risk (e.g., coronary artery disease, diabetes, prior TIA/CVA, or chronic kidney disease).
5 Active Policies
ANTHEM-SURG.00135, SURG.00135 Renal Sympathetic Nerve Ablation
BCBSIL-SUR701.030, Renal Denervation for Uncontrolled Hypertension
BCBSMT-SUR701.030, Renal Denervation for Uncontrolled Hypertension
BCBSNM-SUR701.030, Renal Denervation for Uncontrolled Hypertension
BCBSOK-SUR701.030, Renal Denervation for Uncontrolled Hypertension
Related Codes
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