C1736, Catheter(s), intravascular for renal denervation, ultrasound, including all
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Covered without prior authorization by at least one policy, though another does not cover it (medium 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).