Aetna, a CVS Health company, considers all forms of renal sympathetic nerve ablation — including radiofrequency, microwave, ultrasound, and cryoablation — experimental and investigational across every indication, effective December 20, 2025. Here's what billing teams need to know.
CPB 0847 Aetna is the clinical policy bulletin covering renal sympathetic denervation procedures. The December 20, 2025 update to this coverage policy confirms that no version of this procedure — not the catheter-based radiofrequency approach, not cryoablation via CPT 0338T–0339T, not transurethral denervation via CPT 0935T — gets coverage for any diagnosis, including hypertension, heart failure, or cardiac arrhythmias. If your team bills renal sympathetic nerve ablation for Aetna members, this policy means denials across the board.
Quick-Reference: Aetna CPB 0847 Renal Sympathetic Nerve Ablation 2025
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Renal Sympathetic Nerve Ablation — CPB 0847 |
| Policy Code | CPB 0847 |
| Change Type | Modified |
| Effective Date | December 20, 2025 |
| Impact Level | High — blanket non-coverage across all indications and all ablation modalities |
| Specialties Affected | Interventional cardiology, nephrology, interventional radiology, urology |
| Key Action | Flag CPT 0338T, 0339T, and 0935T in your charge capture system as non-covered for all Aetna members before scheduling or billing |
Aetna Renal Sympathetic Nerve Ablation Coverage Criteria and Medical Necessity Requirements 2025
The short answer: there are no coverage criteria because Aetna covers none of this.
The Aetna renal sympathetic nerve ablation coverage policy under CPB 0847 classifies every form of this procedure as experimental, investigational, or unproven. That classification applies regardless of diagnosis, regardless of ablation modality, and regardless of how the approach is documented in the medical record.
Medical necessity is not the issue here. Even a perfectly documented case with extensive prior treatment failure doesn't change Aetna's position. The denial driver is the experimental designation itself — and Aetna's basis is insufficient evidence in the peer-reviewed literature.
The source policy does not address prior authorization pathways. Consult your Aetna provider agreement and current PA requirements separately before submitting any prior auth requests for these procedures.
The renal sympathetic nerve ablation billing problem here is structural, not administrative. The procedure is categorized alongside other investigational interventions, and reimbursement is blocked at the policy level, not the claim level.
Aetna Renal Sympathetic Nerve Ablation Exclusions and Non-Covered Indications
This section is unusually broad. Most payer exclusion lists target specific indications or specific approaches. CPB 0847 excludes everything.
Aetna draws no distinction between approaches. Catheter-based radiofrequency ablation, microwave ablation, ultrasound ablation, transurethral radiofrequency ablation via renal pelvic denervation, and cryoablation are all experimental. The same classification applies to any indication — Aetna's policy text explicitly states the indication list is "not all-inclusive."
Here are the specific indications Aetna calls out:
| # | Excluded Procedure |
|---|---|
| 1 | Hypertension (including resistant hypertension — I10 through I16.9) |
| 2 | Heart failure |
| 3 | Acute myocardial infarction (I21.1–I21.4) |
| 4 | Cardiac arrhythmias, including ventricular tachycardia and atrial fibrillation (I47.x, I48.x) |
| 5 | Chronic kidney-related pain (G89.29) |
| 6 | Chronic renal failure |
| 7 | Obstructive sleep apnea (G47.33) |
Hypertension gets the most clinical attention in the research literature, and it's the diagnosis where billing teams are most likely to see renal denervation attempted. Doesn't matter. Aetna covers none of it.
Transurethral renal pelvic denervation — billed with CPT 0935T — gets its own specific callout in the policy. Aetna considers it experimental for hypertension and all other indications. That "all other indications" language is intentional and broad.
Coverage Indications at a Glance
| Indication | Coverage Status | Relevant Codes | Notes |
|---|---|---|---|
| Hypertension (all types) | Not Covered — Experimental | I10–I16.9; CPT 0338T, 0339T, 0935T | Applies to all ablation modalities; most common claim scenario |
| Heart failure | Not Covered — Experimental | CPT 0338T, 0339T | No modality distinction |
| Acute myocardial infarction | Not Covered — Experimental | I21.1, I21.2, I21.3, I21.4; CPT 0338T, 0339T | STEMI and NSTEMI both excluded |
| Cardiac arrhythmias (including ventricular tachycardia) | Not Covered — Experimental | I47.0–I47.9; CPT 0338T, 0339T | Paroxysmal tachycardia subcodes included |
| Atrial fibrillation and flutter | Not Covered — Experimental | I48.x (extensive subcode range); CPT 0338T, 0339T | All AF/flutter subcodes covered by exclusion |
| Chronic kidney-related pain | Not Covered — Experimental | G89.29; CPT 0338T, 0339T | Explicitly named in policy |
| Chronic renal failure | Not Covered — Experimental | CPT 0338T, 0339T | No specific ICD-10 carved out; all-inclusive language applies |
| Obstructive sleep apnea | Not Covered — Experimental | G47.33; CPT 0338T, 0339T | Adult and pediatric both excluded |
| Transurethral renal pelvic denervation (all indications) | Not Covered — Experimental | CPT 0935T | Gets separate callout in policy; "all other indications" language |
| Cryoablation of renal sympathetic nerve (all indications) | Not Covered — Experimental | CPT 0338T, 0339T | Specific cryoablation callout; no indication exceptions |
Aetna Renal Sympathetic Nerve Ablation Billing Guidelines and Action Items 2025
The effective date of December 20, 2025 is already passed, which means this policy is in force right now. If your team hasn't acted yet, here's what to do immediately.
| # | Action Item |
|---|---|
| 1 | Flag CPT 0338T, 0339T, and 0935T in your charge capture system as non-covered for all Aetna plans. Don't wait for a claim denial to surface the problem. Pull your charge master and add a hard stop or alert for these codes on Aetna accounts. |
| 2 | Review any pending claims with CPT 0338T, 0339T, or 0935T billed to Aetna. If claims went out after December 20, 2025, expect denials. Get ahead of the appeals queue by identifying them now. |
| 3 | Check your Aetna provider agreement for prior authorization requirements. CPB 0847 does not address PA pathways. Your provider agreement and Aetna's current PA criteria are the right source for that guidance — not this policy alone. |
| 4 | Audit any recently approved prior auths. If your team received a prior auth approval before December 20, 2025, check whether the service was rendered before the effective date. Approvals issued before the policy update may not protect you for claims submitted after it. |
| 5 | Update your patient financial counseling protocols. If a provider plans to perform renal sympathetic denervation on an Aetna member, the patient needs to know this is not a covered benefit before the procedure. That conversation protects you from billing disputes and potential balance billing complaints. |
| 6 | Check your other payer policies for parallel language on renal denervation. CPB 0847 applies to Aetna only. Review your UnitedHealthcare and Cigna policies on renal sympathetic ablation separately to understand your full exposure across payers. |
| 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
All CPT codes listed under CPB 0847 are classified as non-covered due to the experimental designation. There are no covered CPT codes under this policy.
| Code | Type | Description | Reason for Non-Coverage |
|---|---|---|---|
| 0338T–0339T | CPT | Transcatheter renal sympathetic denervation, percutaneous approach including arterial puncture, selective catheter placement... (description truncated in source) | Classified as experimental/investigational for all indications; includes cryoablation approach |
| 0935T | CPT | Cystourethroscopy with renal pelvic sympathetic denervation, radiofrequency ablation, retrograde ureteropyeloscopy | Transurethral renal pelvic denervation — experimental for hypertension and all other indications |
Key ICD-10-CM Diagnosis Codes Under CPB 0847
These are the diagnosis codes Aetna maps to CPB 0847. Claims submitted with these codes paired with CPT 0338T, 0339T, or 0935T will be denied as experimental.
| Code | Description |
|---|---|
| G47.33 | Obstructive sleep apnea (adult) (pediatric) |
| G89.29 | Other chronic pain (kidney-related) |
| I10–I16.9 | Hypertensive disease (full range) |
| I21.1 | ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction |
| I21.2 | ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction |
| I21.3 | ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction |
| I21.4 | ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction |
| I47.0–I47.9 | Paroxysmal tachycardia |
| I48.0–I48.63 | Atrial fibrillation and flutter |
Aetna maps 129 ICD-10-CM codes to CPB 0847. The atrial fibrillation and flutter range (I48.x) accounts for the majority. Every code in that range pairs with the same experimental designation.
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