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    • Medicare coverage of the Symplicity™ blood pressure procedure

    The Symplicity™ procedure is covered by Medicare for patients who meet certain requirements.1 If you have a diagnosis of uncontrolled high blood pressure† (also called hypertension), your Symplicity™ procedure could be covered by Medicare. Talk with your doctor to determine if you are eligible.

    You may qualify if you:

    • Have uncontrolled high blood pressure that is above or equal to 140/90 mmHg, as confirmed by special monitoring†
    • Consistently try prescribed medications as tolerated and try doctor-recommended lifestyle changes to manage your blood pressure for at least six weeks
    • Have been evaluated by your doctor for other causes of high blood pressure, also known as secondary hypertension
    • See a doctor for your high blood pressure three or more times over at least a six-month period, including a minimum of one in-person visit

    Note: The procedure will not be covered if you have previously had a renal denervation procedure or have certain medical conditions affecting the kidneys or renal arteries.

    For full details, visit the Centers for Medicare & Medicaid Services (CMS) website here.

    The Symplicity™ blood pressure procedure isn’t for patients2:

    • Who are pregnant
    • Who have renal artery fibromuscular dysplasia (FMD) causing narrowing of the arteries
    • With a bulging or weakened area in the kidney
    • With renal artery diameter narrowing caused by plaque buildup > 50%
    • With an abnormal kidney tumor
    • Who have had a renal stent placed less than three months prior to the procedure
    • With renal artery diameter less than 3 mm or greater than 8 mm

    Private insurance coverage for the Symplicity™ procedure

    Private coverage includes: self-purchased, employer-provided, and Medicare Advantage plans. The Symplicity™ procedure is an innovative treatment, and coverage policies are still evolving. Coverage can vary depending on your insurance plan, so it’s a good idea to check with your insurance company to understand what’s covered. When speaking with them, you need to refer to the procedure as renal denervation, which is the technical name used for coding and coverage purposes.

    Coverage for the Symplicity™ blood pressure procedure is growing. The list of participating insurance providers is updated regularly, so your plan may offer coverage even if it didn’t before. If your plan is on the list, keep in mind that policies vary, so prior authorization may still be required. We encourage you to speak with your healthcare provider and insurance company to confirm your plan’s coverage and process.

    Before scheduling the Symplicity™ procedure

    Your doctor may need to get preapproval from your insurance company before you can have the Symplicity™ procedure — a minimally invasive treatment called renal denervation.

    This process can take a couple of weeks and does not require any action from you besides confirming that your doctor has your current insurance information. Not all insurance plans require preapproval for the procedure, so check with your provider.

    Appealing to your insurance company

    If your insurance company denies coverage for the Symplicity™ procedure, you’re not out of options. Many insurance companies allow you to file an appeal, which is a request for them to reconsider their decision. It can be submitted by you or your doctor. 

    The appeal process can take time (sometimes 30 days or more), and the steps may vary depending on your insurance plan. If you receive a denial, check the denial letter for specific instructions on how to appeal the decision. If you are considering an appeal for the Symplicity™ procedure or would like to support your doctor’s appeal, you may find the following resource helpful:

    The Symplicity™ procedure is intended to work alongside lifestyle changes and medications.

    Not every person will experience the same results. Talk with your doctor to see if the Symplicity™ procedure is right for you. Your doctor should discuss all potential benefits and risks with you.

    Confused about insurance coverage?

    If you have questions on the preapproval or appeal process, or to check the status of a request, please contact your insurance company at the phone number on the back of your insurance card.

    Is the Symplicity™ procedure right for you?

    Take our short survey to see if you could be a good candidate for this procedure. Then talk with your doctor to see if this treatment may be right for you.

    Your blood pressure reading has two numbers. The first, or “top” number, is your systolic blood pressure. For example, if your BP is 120/90, 120 is the systolic blood pressure reading.

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