New authorization requirement for renal denervation, effective Apr. 6, 2025

Effective Apr. 6, 2025, we’ll require prior authorization for the following procedures for Medicare cases:

• 0338T: Transcatheter renal sympathetic denervation, percutaneous approach including arterial puncture, selective catheter placement(s) renal artery(ies), fluoroscopy, contrast injection(s), intraprocedural roadmapping and radiological supervision and interpretation, including pressure gradient measurements, flush aortogram and diagnostic renal angiography when performed; unilateral
• 0339T: Transcatheter renal sympathetic denervation, percutaneous approach including arterial puncture, selective catheter placement(s) renal artery(ies), fluoroscopy, contrast injection(s), intraprocedural roadmapping and radiological supervision and interpretation, including pressure gradient measurements, flush aortogram and diagnostic renal angiography when performed; bilateral

As previously shared, we’ll also require prior authorization for these procedures for commercial cases starting Feb. 1, 2025.

Background

These procedures were previously considered not medically necessary under the scope of our medical policy #91636 – Category III Current Procedure Terminology (CPT) Codes as temporary codes for emerging technologies considered to be experimental or investigational.

These codes are now covered for Medicare, effective Oct. 1, 2024, and will be covered for commercial effective Feb. 1, 2025. New medical policy #91644 – Renal Denervation for Resistant Hypertension (to be posted to our Provider Manual on Feb. 1) will include commercial criteria. (Note: These procedures remain not covered for Medicaid.)

Requesting authorization

Authorization requests for 0338T and 0339T will be submitted through GuidingCare, accessed through prism’s authorizations request tool (login required).