TL;DR: Aetna, a CVS Health company, confirmed its position under CPB 0847 — renal sympathetic nerve ablation is experimental, investigational, or unproven for every indication it covers, effective December 20, 2025. If your team bills CPT 0338T, 0339T, or 0935T to Aetna, expect automatic denials.
Aetna's renal sympathetic nerve ablation coverage policy leaves no room for interpretation. Under CPB 0847, Aetna classifies microwave, radiofrequency, ultrasound, and cryoablation of the renal sympathetic nerve as experimental for eight named indications — including hypertension, heart failure, and cardiac arrhythmias. The same designation applies to transurethral renal pelvic denervation using CPT 0935T. This policy update was effective December 20, 2025.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Renal Sympathetic Nerve Ablation |
| Policy Code | CPB 0847 |
| Change Type | Modified |
| Effective Date | December 20, 2025 |
| Impact Level | High |
| Specialties Affected | Interventional cardiology, nephrology, interventional radiology, urology |
| Key Action | Stop billing CPT 0338T, 0339T, and 0935T to Aetna without a documented appeals strategy — all are non-covered under this policy |
Aetna Renal Sympathetic Nerve Ablation Coverage Criteria and Medical Necessity Requirements 2025
The short answer on medical necessity here: there is none that Aetna will accept.
CPB 0847 is a blanket non-coverage policy. Aetna does not cover renal sympathetic denervation for any modality or indication listed in this bulletin. There are no carve-outs, no tiered criteria, and no pathway to prior authorization that leads to approval. If a clinician believes the procedure is medically necessary, Aetna's position is that the peer-reviewed literature doesn't support that claim.
This matters most for practices billing in interventional cardiology and nephrology. Physicians who perform renal denervation for resistant hypertension — a real clinical population with limited options — will find no reimbursement pathway here. Aetna's coverage policy treats the evidence base as insufficient across every modality.
Prior authorization won't save these claims. If your team submits a prior auth request for CPT 0338T or 0935T on an Aetna member, expect a denial based on experimental status — not a request for more documentation. The medical necessity criteria simply aren't met by definition under this policy.
Aetna Renal Sympathetic Nerve Ablation Exclusions and Non-Covered Indications
This entire policy is an exclusion list. Every indication Aetna named is non-covered.
Aetna classifies three separate modality categories as experimental, investigational, or unproven:
Microwave, radiofrequency, or ultrasound ablation of the renal sympathetic nerve is not covered for any of the following:
| # | Excluded Procedure |
|---|---|
| 1 | Acute myocardial infarction (ICD-10 I21.1–I21.4) |
| 2 | Cardiac arrhythmias, including paroxysmal tachycardia (I47.0–I47.9) and atrial fibrillation/flutter (I48.x) |
| 3 | Chronic kidney-related pain (G89.29) |
| 4 | Chronic renal failure |
| 5 | Heart failure |
| 6 | Hypertension and hypertensive disease (I10–I16.9) |
| 7 | Obstructive sleep apnea (G47.33) |
| 8 | Ventricular tachycardia |
Transurethral renal pelvic denervation using radiofrequency ablation — billed under CPT 0935T — is experimental for hypertension and all other indications. No exceptions.
Cryoablation of the renal sympathetic nerve — billed under CPT 0338T and 0339T — is experimental for hypertension and all other indications. Same result.
The real issue here is the breadth of this policy. Most experimental designation policies carve out specific indications or modalities. CPB 0847 doesn't. Aetna looked at every way this procedure gets done and every condition it's tried for, and denied them all. That's a significant position for payers to take on a procedure that has active FDA-cleared devices in the U.S. market.
If you're treating resistant hypertension patients and believe there's a strong clinical case, talk to your compliance officer before submitting any claims. An appeal strategy requires documentation that goes well beyond standard medical necessity criteria — you'd be arguing against Aetna's explicit evidence standard.
Coverage Indications at a Glance
| Indication | Status | Relevant CPT Codes | Relevant ICD-10 Codes | Notes |
|---|---|---|---|---|
| Acute myocardial infarction | Experimental / Not Covered | 0338T, 0339T | I21.1–I21.4 | Insufficient peer-reviewed evidence per Aetna |
| Cardiac arrhythmias (incl. atrial fibrillation, flutter, paroxysmal tachycardia) | Experimental / Not Covered | 0338T, 0339T | I47.0–I47.9, I48.0–I48.6x | All arrhythmia subtypes excluded |
| Chronic kidney-related pain | Experimental / Not Covered | 0338T, 0339T | G89.29 | Named specifically in CPB 0847 |
| Chronic renal failure | Experimental / Not Covered | 0338T, 0339T | See ICD-10 table below | No coverage regardless of modality |
| Heart failure | Experimental / Not Covered | 0338T, 0339T | See ICD-10 table below | No coverage regardless of modality |
| Hypertension / Hypertensive disease | Experimental / Not Covered | 0338T, 0339T, 0935T | I10–I16.9 | All three modality categories excluded; 0935T specifically designated for hypertension under transurethral approach |
| Obstructive sleep apnea | Experimental / Not Covered | 0338T, 0339T | G47.33 | Explicitly named in policy |
| Ventricular tachycardia | Experimental / Not Covered | 0338T, 0339T | See ICD-10 table below | Named as separate indication from arrhythmias |
| Transurethral renal pelvic denervation — all indications | Experimental / Not Covered | 0935T | All relevant ICD-10 | No indication is covered for this approach |
Note on CPT code assignments: The source policy links 0338T–0339T to cryoablation of the renal sympathetic nerve, and 0935T to transurethral renal pelvic denervation via radiofrequency ablation. The eight named indications are explicitly listed under the microwave/radiofrequency/ultrasound and cryoablation modality categories. For the transurethral approach (0935T), Aetna names hypertension and all other indications as non-covered.
Aetna Renal Sympathetic Nerve Ablation Billing Guidelines and Action Items 2025
The effective date is December 20, 2025. Here's what your billing team should do now.
| # | Action Item |
|---|---|
| 1 | Flag CPT 0338T, 0339T, and 0935T in your charge capture system. Add a payer-specific edit that prevents Aetna claims from going out without review. Renal denervation billing to Aetna will deny — every time, for every indication. A charge capture flag stops claims before they create AR problems. |
| 2 | Pull your Aetna AR for any outstanding claims with these codes. If you have claims in flight under CPT 0338T, 0339T, or 0935T with Aetna, work them now. Don't wait for the remittance. A proactive review saves time on the back end. |
| 3 | Check your denial remark codes on any past Aetna claims for these procedures. If you've been billing these CPT codes and receiving denials, confirm the denial reason aligns with experimental/investigational status. This tells you whether your denial patterns were already matching this policy or whether something else was driving them. |
| 4 | Do not submit prior authorization requests expecting approval. Prior auth for experimental procedures doesn't produce approvals under Aetna's framework. If your team is in the habit of submitting PA requests to document the attempt, continue that for compliance records — but don't hold care decisions on the expectation of authorization. |
| 5 | Document patient financial counseling before any procedure. If physicians plan to perform renal sympathetic denervation anyway — for resistant hypertension patients, for example — your team needs to counsel patients that Aetna will not reimburse this service. Get a signed financial agreement before scheduling. This protects the practice and the patient. |
| 6 | Review CPB 0820 (Carotid Sinus Stimulation for Hypertension) as a related policy. Aetna explicitly cross-references this bulletin. If you have patients who've explored multiple device-based hypertension treatments, confirm the coverage status on each approach separately. The billing guidelines for carotid sinus stimulation are distinct from CPB 0847. |
| 7 | If you're considering an appeal, loop in your compliance officer first. Appeals that challenge experimental designations require clinical literature and a specific argument about evidence sufficiency. That's a higher bar than most standard medical necessity appeals. Your billing team shouldn't build that argument alone. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Renal Sympathetic Nerve Ablation Under CPB 0847
Not Covered / Experimental CPT Codes
Every CPT code in this policy carries experimental status. There are no covered codes under CPB 0847.
| Code | Type | Description | Coverage Status |
|---|---|---|---|
| 0338T–0339T | CPT | Transcatheter renal sympathetic denervation, percutaneous approach including arterial puncture, sele… (source description truncated) | Experimental / Not Covered — cryoablation of the renal sympathetic nerve |
| 0935T | CPT | Cystourethroscopy with renal pelvic sympathetic denervation, radiofrequency ablation, retrograde ureteroscopy (source description truncated) | Experimental / Not Covered — transurethral renal pelvic denervation |
Key ICD-10-CM Diagnosis Codes Referenced in CPB 0847
| Code | Description |
|---|---|
| G47.33 | Obstructive sleep apnea (adult) (pediatric) |
| G89.29 | Other chronic pain — kidney-related |
| I10–I16.9 | Hypertensive disease (all subcategories) |
| I21.1–I21.4 | ST elevation (STEMI) and non-ST elevation NSTEMI myocardial infarction |
| I47.0–I47.9 | Paroxysmal tachycardia |
| I48.0–I48.6x | Atrial fibrillation and flutter (all subcategories) |
The ICD-10 code range for atrial fibrillation and flutter (I48.x) covers 49+ subcategories in this policy. If your practice treats AF patients and has explored renal denervation as adjunctive therapy, every one of those subcategories is non-covered under CPB 0847.
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