The U.S. Food and Drug Administration (FDA) last year approved of ultrasound  and radiofrequency ablation-based renal denervation devices that can be used to “reduce blood pressure as an adjunctive treatment in patients with uncontrolled hypertension in whom lifestyle modifications and antihypertensive medications do not adequately control blood pressure.”

These approvals have provided clinicians with new tools to reduce blood pressure with the goal of reducing cardiovascular events in qualifying patients. The ACC reminds members that clinicians and payers can use the following Category III CPT® codes to report the performance of these procedures:

• 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:                  bilateral
  

  Do not report 0338T, 0339T in conjunction with 36251, 36252, 36253, 36254
  For quantitative pupillometry with interpretation and report, unilateral or bilateral, use 95919
  Note: CPT codes, descriptions and other data are copyright 2024 American Medical Association. All rights reserved.

Because Category III CPT codes are used to collect usage data on emerging technologies and services, they do not generally have payment rates or relative value units assigned. They may not have an assigned allowable payment for insurance purposes, making patients responsible for services. Clinicians and facilities that furnish these services will likely benefit from outreach to payers to learn if and how services will be paid, what documentation is necessary, and other details.

For patients with Medicare Part B, obtaining advance beneficiary notices (ABNs) can be useful, informing them they may have to pay out of pocket. Such claims should be reported with modifier -GA to indicate an ABN is on file.

When billing Category III codes for a service that is FDA approved, it can be useful to provide payers with a crosswalk code as a means of payment. Clinicians familiar with the services from clinical trials have indicated the service is comparable from several perspectives – access, intensity, time – to intravascular stent placement in the renal artery, reported with codes 37236 and 37237. Those services may be a useful reference in discussions with payers.