Cardiac Computed Tomography (CT), Coronary CT Angiography,Calcium Scoring and CT Fractional Flow Reserve — CPB 0228 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0228 covering cardiac CT, coronary CT angiography (CCTA), calcium scoring, and CT fractional flow reserve, effective February 27, 2026. If your team bills CPT 75574, 75571, 75572, 75573, or 75580 for Aetna members, read this before submitting your next claim.

This update to the Aetna cardiac CT coverage policy touches 71 CPT codes, one HCPCS code, and over 120 ICD-10-CM diagnosis codes. The policy also adds explicit guidance on newer technology codes—including 0623T through 0626T for coronary plaque analysis and CT-FFR, and 0992T/0993T, which Aetna now explicitly excludes. Cardiac imaging billing teams have real exposure here, especially anyone billing the newer Category III codes without checking CPB 0228 Aetna first.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Cardiac Computed Tomography (CT), Coronary CT Angiography, Calcium Scoring and CT Fractional Flow Reserve
Policy Code	CPB 0228
Change Type	Modified
Effective Date	February 27, 2026
Impact Level	High
Specialties Affected	Cardiology, Radiology, Cardiac Surgery, Electrophysiology, Cardiovascular Imaging
Key Action	Audit charge capture for Category III codes 0992T and 0993T — Aetna now explicitly excludes both

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Aetna Cardiac CT and CCTA Coverage Criteria and Medical Necessity Requirements 2026

The real issue with CPB 0228 is precision. Aetna's cardiac CT coverage policy doesn't just ask whether your patient has chest pain. It asks what their pre-test probability is, how you calculated it, and whether you used Framingham risk scoring, Pooled Cohort Equations, or ACC criteria. Getting the medical necessity documentation wrong on these claims is a fast path to a claim denial.

CCTA of the Coronary Arteries (CPT 75574)

Aetna covers CCTA using 64-slice or greater for nine distinct indications. Each has its own documentation requirements. The broadest category covers ruling out obstructive coronary stenosis in symptomatic patients with low or intermediate pre-test probability of coronary artery disease or atherosclerotic cardiovascular disease. Your documentation must reference one of three accepted risk stratification tools: Framingham, Pooled Cohort Equations, or ACC criteria.

A second covered indication: patients with a positive stress test (≥1 mm ST segment depression) who also have a low or intermediate pre-test probability by the same risk tools. Don't assume the positive stress test alone gets you there — Aetna wants the pre-test probability documented too.

Asymptomatic patients are covered only at intermediate pre-test probability, and only when the stress test is equivocal, uninterpretable, or when resting ECG changes (LBBB, pathologic Q-waves, RBBB with LAFB) suggest CAD as a possible cause. Aetna includes a pointed note here: the American Heart Association recommends against routine stress testing for asymptomatic adults. That note is in the policy for a reason — Aetna is flagging that they'll scrutinize these claims.

Preoperative and Procedural Indications

Aetna covers CCTA for preoperative assessment before high-risk non-cardiac surgery when an imaging stress test or invasive coronary angiography is being deferred. The ACC defines high-risk surgery as emergent operations (especially in the elderly), aortic and major vascular surgeries, peripheral vascular surgeries, and prolonged abdominal or thoracic procedures with significant fluid shifts or blood loss.

For planned non-coronary cardiac surgery — valve repair, congenital heart disease correction, pericardial disease — CCTA is covered as an alternative to cardiac catheterization as the initial imaging study, but only in patients with low or intermediate pretest risk of obstructive CAD.

CCTA before transcatheter aortic valve replacement (TAVR) — billed under CPT codes 33361 through 33369 — is explicitly covered for aortic valve annulus assessment.

CT Fractional Flow Reserve (CPT 75580 and 0626T)

CT-FFR coverage requires a prior CCTA showing coronary artery disease of uncertain functional significance, or a non-diagnostic CCTA. You can't bill 75580 or 0626T as a standalone without that preceding CCTA result. Document the prior study clearly in the record and on the claim.

Calcium Scoring (CPT 75571) and HCPCS S8092

Calcium scoring is covered for asymptomatic patients when specific risk criteria are met. HCPCS S8092 — covering electron beam CT (ultrafast CT, cine CT) — is listed as covered when policy indications are met. This is worth noting because S8092 doesn't show up on every team's radar for prior authorization workflows.

Pulmonary Vein Mapping

CCTA for cardiac morphology and pulmonary vein mapping (CPT 75572, 75573) is covered for two specific indications: biventricular pacemaker patients needing coronary vein mapping for lead placement, and patients undergoing pulmonary vein isolation for atrial fibrillation (both pre- and post-ablation). If your electrophysiology program bills these, make sure the indication language in your documentation matches one of those two exactly.

Coronary Anomalies in Young Patients

Detection and delineation of suspected coronary anomalies is covered in patients under 40 with suggestive symptoms. The policy lists specific symptoms by age group. For adults and children: angina, syncope, arrhythmia, and exertional dyspnea without another known cause. For infants: dyspnea, tachypnea, wheezing, pallor, irritability (episodic crying), diaphoresis, poor feeding, and failure to thrive. If you're billing this indication for a pediatric patient, your documentation needs to match one of these clinical pictures.

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Aetna Cardiac CT Exclusions and Non-Covered Indications

Aetna's CPB 0228 explicitly excludes four Category III codes. These are not gray areas — they're listed under "CPT codes not covered for indications listed in the CPB."

0992T and 0993T — Perivascular Fat Analysis

These two codes cover noninvasive cardiac risk assessment derived from software analysis of perivascular fat attenuation using CT data. Aetna does not cover either code. If your radiology group or cardiology practice recently added these to your charge capture, remove them from Aetna claims now.

0721T and 0722T — Quantitative CT Tissue Characterization

These codes cover quantitative CT tissue characterization, including interpretation and report. Aetna also excludes both. These are distinct from the covered plaque analysis codes (0623T–0626T), so don't mix them up in your billing.

The line between covered plaque analysis (0623T–0626T, the Cleerly Coronary Report pathway) and excluded tissue characterization (0721T, 0722T) is genuinely narrow. If your team is billing any of these, loop in your compliance officer before the February 27, 2026 effective date to confirm you're on the right side of that line.

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Coverage Indications at a Glance

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Aetna Cardiac CT Billing Guidelines and Action Items 2026

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Cardiac CT Under CPB 0228

Covered CPT Codes (When Selection Criteria Are Met)

Not Covered / Experimental Codes

Covered HCPCS Codes

Code	Type	Description Copy
S8092	HCPCS	Electron beam computed tomography (ultrafast CT, cine CT)

Key ICD-10-CM Diagnosis Codes

The full ICD-10-CM list for CPB 0228 includes 120+ codes. Review the complete list at Aetna CPB 0228 before building your payer-specific billing guidelines.

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