CMS Pub. 100-04, ch. 32, § 416.2

Effective for claims with dates of service on and after June 9, 2025, contractors shall pay claims for RADs

with or without a backup rate feature and HMVs, in the home, as treatment for patients with CRF

consequent to COPD under the conditions and coverage criteria outlined in Pub. 100-03, Medicare NCD

Manual, Chapter 1, Section 240.9.

RAD:

Contractors shall allow NIPPV claims submitted with HCPCS code E0470 or E0471 with KX modifier.

NOTE: All national ICD-10 diagnosis codes shall be managed locally by the MACs.

HMV:

Contractors shall allow NIPPV claims submitted with HCPCS code E0466, E0467, or E0468.

For the multifunction ventilators (E0467 and E0468), a beneficiary would need to meet the ventilator

criteria plus the criteria for one of the other functions for coverage.

NOTE: All national ICD-10 diagnosis codes shall be managed locally by the MACs.

Patients must be evaluated at least twice within the first year after initially receiving a RAD or HMV.

Evaluations must occur by the end of the six-month initial coverage period and again during months 7-12.

417 Renal Denervation (RDN) for Uncontrolled Hypertension – Coverage

(Rev. 13802; Issued: 05-28-26; Effective: 10-28-25; Implementation: 04-06-26)

Effective for claims with dates of service on or after October 28, 2025, the Centers for Medicare &

Medicaid Services (CMS) covers radiofrequency renal denervation (rfRDN) and ultrasound renal

denervation (uRDN) (collectively, RDN) for uncontrolled hypertension under Coverage with Evidence

Development (CED). Refer to the criteria outlined in Publication 100-03, Chapter 1, section 20.40.

417. 1 Coding Requirements:

(Rev. 13802; Issued: 05-28-26; Effective: 10-28-25; Implementation: 04-06-26)

Type of Bill (TOB) 11X

International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) codes:

• X051329: Destruction of Renal Sympathetic Nerve(s) using Ultrasound Ablation, Percutaneous

Approach, New Technology Group 9

Note: Recor Medical’s Paradise® Ultrasound Renal Denervation

• X05133A: Destruction of Renal Sympathetic Nerve(s) using Radiofrequency Ablation,

Percutaneous Approach, New Technology Group 10

Note: Medtronic’s Symplicity Spyral™ Renal Denervation System, and

• ICD-10-CM diagnosis Z00.6 (reported as other diagnosis), and

• Value code D4 with the 8-digit National Clinical Trial (NCT), and

• Condition code 30, and 04 (if appropriate)

ICD-10-CM diagnosis is one of the following:

• I10:Essential (primary) hypertension

• I11.0:Hypertensive heart disease with heart failure

• I11.9:Hypertensive heart disease without heart failure

• I12.0:Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal

disease

• I12.9:Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or

unspecified chronic kidney disease

• I13.0:Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4

chronic kidney disease, or unspecified chronic kidney disease

• I13.10:Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through

stage 4 chronic kidney disease, or unspecified chronic kidney disease

• I13.11:Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic

kidney disease, or end stage renal disease

• I13.2:Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic

kidney disease, or end stage renal disease

• I15.0:Renovascular hypertension

• I15.1:Hypertension secondary to other renal disorders

• I15.2:Hypertension secondary to endocrine disorders

• I15.8:Other secondary hypertension

• I15.9:Secondary hypertension, unspecified

• I16.0:Hypertensive urgency

• I16.1:Hypertensive emergency

• I16.9:Hypertensive crisis, unspecified

• I1A.0:Resistant hypertension

Please note:

ICD-10-CM classifies hypertension by type as essential or primary (categories I10-I13), secondary

(category I15), hypertensive crisis (category I16), and resistant (category I1A).

ICD-10-CM does not distinguish between controlled vs. uncontrolled hypertension.

TOB 13X and Professional Claims:

CPT Codes:

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

Professional Claims only:

0935T :Cystourethroscopy with renal pelvic sympathetic denervation, radiofrequency ablation, retrograde

ureteral approach, including insertion of guide wire, selective placement of ureteral sheath(s) and multiple

conformable electrodes, contrast injection(s), and fluoroscopy, bilateral

HCPCS Codes:

C1735:Catheter(s), intravascular for renal denervation, radiofrequency, including all single use system

components

Note: Device code for Medtronic’s Symplicity Spyral™ Renal Denervation System

C1736:Catheter(s), intravascular for renal denervation, ultrasound, including all single use system

components

Note: Device code for Recor Medical’s Paradise® Ultrasound Renal Denervation