How to get reimbursed for renal denervation
Hospitals interested in launching renal denervation (RDN) programs for patients with uncontrolled hypertension are entering the field at a pivotal moment, with Medicare coverage starting to take shape.
In late October 2025, the Centers for Medicare and Medicaid Services (CMS) finalized a national coverage determination (NCD) to cover both radiofrequency renal denervation (rfRDN) and ultrasound renal denervation (uRDN) for uncontrolled hypertension under Coverage with Evidence Development (CED). The decision follows a growing body of randomized trial data supporting the safety and efficacy of the procedure and the recent FDA approvals of two RDN devices.
Herbert D. Aronow, MD, MPH, medical director of the heart and vascular service line and the Benson Ford Chair in Cardiology at Henry Ford Health and member of the Society for Cardiovascular Angiography and Interventions (SCAI) board, outlined what hospitals need to know about building compliant programs and navigating reimbursement during a session at TCT 2025 in San Francisco. He spoke with Cardiovascular Business for an exclusive video interview at that same conference.
“This is a really exciting time in the RDN space, really more broadly in the hypertension space,” Aronow said. He pointed to innovations and recent trials that have renewed enthusiasm for RDN as a way to improve blood pressure control and reduce downstream morbidity and mortality.
According to Aronow, the new NCD clearly defines the framework hospitals must follow to qualify for Medicare coverage.
Eligible patients include those with blood pressures above 140/90 who are managed by a multispecialty care team, at sites where both the facility and operators meet specific criteria and where there has been an attempt to treat patients with guideline-directed medical therapy. A key element of the CMS decision is that coverage will be conditional.
“It looks like this will be coverage with evidence development, which means that it's conditional coverage from Medicare that will require a collection of additional data through registries and other means,” Aronow explained.
As a result, hospitals cannot simply add RDN to their procedural offerings. “You need a hypertension program that's multi-specialty, multidisciplinary. You need that registry. You need people who are qualified to do this. You need a facility that can support it,” he explained, adding that “there's a lot of work that needs to go into it.”
Financial considerations are another hurdle. Aronow acknowledged that the early economics were challenging and contributed to a cautious uptake. He said programs need to be deliberate in their rollout and understand all the things that are needed to be reimbursed.
“We need to be really thoughtful about how we roll this out because we can't just start doing procedures where we might lose money on every procedure,” Aronow said.
With Medicare now reimbursing for RDN, he expects the picture to improve. He also thinks permanent CPT code could be announced in the next year or two.
Despite the near-term challenges, Aronow suggested hospitals view RDN through a broader strategic lens, similar to the early days of transcatheter aortic valve replacement (TAVR). Early on, TAVR was not reimbursed, but hospitals performing the procedure found that more and more patients were being referred or seeking out the minimally invasive procedure to avoid open heart surgery. While most did not qualify for TAVR, having a discussion about surgical durability with a cardiologist actually increased surgical referrals, and that is where hospitals found ROI.
Aronow said there is also a halo effect with most innovative program attracting new patients that can lead to additional downstream care, imaging and procedures that strengthen the overall service line.
“They become consumers of health through your system,” Aronow said.
For now, Aronow advised hospitals to proceed carefully but optimistically. With Medicare coverage established and reimbursement mechanisms still evolving, success will depend on building structured, multidisciplinary programs that meet CMS requirements while positioning institutions for future payment improvements.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]