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DESCRIPTIONRadiofrequency ablation (RFA) of the renal sympathetic nerves is a non-pharmacologic treatment for hypertension. This treatment is intended to reduce sympathetic nerve activity in the renal system, thus leading to lower blood pressure. Patients with hypertension that is resistant to treatment with standard medications may derive benefit from this approach.
There are a number of factors that may contribute to uncontrolled hypertension, and these should be considered and addressed in all patients with hypertension prior to labeling a patient resistant. These include non-adherence to medications, excessive salt intake, inadequate doses of medications, excess alcohol intake, volume overload, drug-induced hypertension, and other forms of secondary hypertension. Also, sometimes it is necessary to address comorbid conditions, i.e., obstructive sleep apnea, in order to adequately control BP.
Treatment for resistant hypertension is mainly intensified drug therapy, sometimes with the use of non-traditional antihypertensive medications such as spironolactone and/or minoxidil. However, control of resistant hypertension with additional medications is often challenging and can lead to high costs and frequent adverse effects of treatment. As a result, there is a large unmet need for additional treatments that can control resistant hypertension. Non-pharmacologic interventions for resistant hypertension include modulation of the baroreflex receptor, and/or radiofrequency (RF) denervation of the renal nerves.
Radiofrequency Denervation of the Renal Sympathetic Nerves
The procedure is performed percutaneously with access at the femoral artery. A flexible catheter is threaded into the renal artery and controlled, low-power RF energy is delivered to the arterial walls where the renal sympathetic nerves are located. Once adequate RF energy has been delivered to ablate the sympathetic nerves, the catheter is removed.
No RFA devices have been approved for ablation of the renal sympathetic nerves as a treatment for hypertension. There are several devices that have been developed for this purpose and are in various stages of application for U.S. Food and Drug Administration (FDA) approval. The Symplicity™ renal denervation device (Medtronic, Inc.) consists of a flexible catheter that is specifically intended for use in the renal arteries, and an external power generator. Other devices under development for this purpose include the Biosense Webster Thermocouple Catheter™, which has been used for cardiac electrophysiology procedures, and the St. Jude Medical EnligHTN™ multi-electrode renal denervation system.
POLICYRadiofrequency ablation of the renal sympathetic nerves is considered investigational for the treatment of resistant hypertension.
POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY11/15/2012: Approved by Medical Policy Advisory Committee.
10/22/2013: Policy reviewed; no changes.
SOURCE(S)Blue Cross Blue Shield Association policy # 7.01.136
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.