TL;DR: Aetna, a CVS Health company, modified CPB 0382 covering intravascular ultrasound (IVUS), effective February 25, 2026. Here's what billing teams need to know before your next claim goes out.
The updated Aetna intravascular ultrasound coverage policy tightens the line between covered and non-covered indications across both coronary and non-coronary vascular procedures. The primary billing codes affected are CPT 92978 and 92979 for coronary IVUS, CPT 37252 and 37253 for noncoronary vessel IVUS, and HCPCS C7569 for percutaneous transluminal coronary angioplasty with endoluminal imaging. If your team bills any of these codes for Aetna members, the February 25, 2026 effective date applies to you.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Intravascular Ultrasound — CPB 0382 |
| Policy Code | CPB 0382 |
| Change Type | Modified |
| Effective Date | February 25, 2026 |
| Impact Level | High |
| Specialties Affected | Interventional Cardiology, Vascular Surgery, Cardiac Surgery, Interventional Radiology, Nephrology |
| Key Action | Audit all pending IVUS claims against the eight covered indications and verify documentation supports medical necessity before submitting |
Aetna Intravascular Ultrasound Coverage Criteria and Medical Necessity Requirements 2026
The CPB 0382 Aetna system policy recognizes eight specific clinical scenarios where IVUS meets medical necessity. These aren't loose categories — each one has a defined clinical context. If your documentation doesn't map directly to one of them, the claim is at risk.
Here's what Aetna covers under the updated policy:
1. Coronary stenosis evaluation (50–70% stenosis). IVUS is covered as a clinical decision-making tool when a symptomatic member's angiogram shows 50–70% stenosis. The member must be symptomatic — asymptomatic stenosis doesn't qualify.
2. Left main stem coronary artery disease. IVUS is covered as a conclusive study when suspected left main stem disease wasn't revealed by coronary angiography. This is where CPT 92978 or 92979 should appear on the claim.
3. Vena caval filter placement guidance. IVUS is covered for guiding vena caval filter insertion. CPT codes 37191, 37192, and 37193 are listed as related procedure codes in the policy.
4. Intracoronary device placement and post-procedure assessment. IVUS is covered for guidance and immediate results assessment following angioplasty, atherectomy, and stenting — including procedures on coronary grafts. HCPCS C7569 is specifically listed for PTCA with endoluminal imaging.
5. Cardiac allograft vasculopathy. IVUS is covered for evaluation of cardiac allograft vasculopathy in post-cardiac transplant patients. This is a narrow indication — confirm the member's transplant history is clearly documented.
6. May-Thurner syndrome. IVUS is covered for both diagnosis and follow-up treatment of iliac vein compression syndrome (May-Thurner syndrome) of the lower extremity. CPT 37252 and 37253 apply here for noncoronary vessel imaging.
7. Type B aortic dissection with TEVAR. IVUS is covered when CT imaging was compromised by poor quality or was inconclusive during thoracic endovascular aneurysm repair for type B aortic dissection. CPT 33880 and 33881 are listed as related codes. Document specifically why CT was inadequate — this is the type of coverage policy criterion that gets denied when the clinical notes are vague.
8. Infra-inguinal arterial disease with CO2 angiography. IVUS is covered when a member's renal function or another documented health issue prevents standard contrast angiography, CO2 angiography is being used, and the initial CO2 imaging is suboptimal for clinical decision-making. All three conditions must be documented. This is the most documentation-intensive indication in the policy.
Prior authorization requirements are not explicitly detailed in the CPB 0382 text, but Aetna routinely requires prior auth for interventional procedures. Check the member's plan before scheduling — don't assume the coverage policy alone gets you to reimbursement.
Aetna Intravascular Ultrasound Exclusions and Non-Covered Indications
This is where CPB 0382 does the most work — and where your claim denial risk is highest.
Aetna considers IVUS experimental, investigational, or unproven for the following:
Coronary applications outside the covered indications:
| # | Excluded Procedure |
|---|---|
| 1 | Screening for coronary artery disease |
| 2 | Diagnosing coronary vulnerable plaques |
| 3 | Other coronary procedures not listed above |
Virtual histology IVUS is specifically called out as experimental for evaluation of atherosclerotic plaque. If your cardiologists use VH-IVUS, those claims won't be covered under this policy.
Non-coronary vascular applications not covered:
Aetna explicitly lists 15 non-covered non-coronary indications. The list is broad and directly relevant to vascular surgery and interventional radiology billing teams:
| # | Excluded Procedure |
|---|---|
| 1 | Diagnosis of aortic dissection |
| 2 | Diagnosis or evaluation of pulmonary hypertension |
| 3 | Diagnosis and treatment of functional popliteal artery entrapment syndrome |
| 4 | Use during endovascular interventions of failing hemodialysis access grafts (this one stings for nephrology and access centers — CPT 36901, 36902, and 36903 are listed as related codes, but IVUS during those procedures is not covered) |
| 5 | Evaluation of carotid artery stenosis |
| 6 | Evaluation of chronic venous obstruction or venous stenting |
| 7 | Use in pulmonary artery angioplasty (CPT 92997 and 92998 are listed as related, but IVUS guidance during those procedures is not covered) |
| 8 | Guidance during endovascular treatment of subclavian artery disease |
| 9 | Guidance in percutaneous mechanical thrombectomy for pulmonary embolism treatment |
| 10 | Prediction of clinical improvement following ilio-femoral vein stenting |
| 11 | Prediction of outcome following carotid artery stenting |
| 12 | Stenting of non-coronary arteries |
| 13 | Thoracic endovascular aortic repair for blunt thoracic aortic injury |
| 14 | Treatment of lower extremity arterial occlusive disease that doesn't meet the CO2 angiography criteria above |
| 15 | Other non-coronary vascular procedures (veins included) not specifically listed as covered |
The real issue here is the hemodialysis access exclusion. Many vascular access programs routinely use IVUS during failing graft interventions. If your team bills 37252 or 37253 alongside 36901–36903 for Aetna members, those IVUS codes will deny. Separate your workflows now.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Coronary stenosis evaluation, 50–70%, symptomatic member | Covered | 92978, 92979 | Member must be symptomatic; angiographic documentation required |
| Left main stem coronary artery disease, not revealed by angiography | Covered | 92978, 92979 | Conclusive study use only |
| Vena caval filter placement guidance | Covered | 37252, 37253, 37191–37193 | Guidance indication only |
| Intracoronary device placement and post-procedure assessment (angioplasty, atherectomy, stenting, grafts) | Covered | 92978, 92979, C7569 | Includes coronary graft procedures |
| Cardiac allograft vasculopathy, post-transplant | Covered | 92978, 92979 | Transplant history must be documented |
| May-Thurner syndrome (iliac vein compression), diagnosis and follow-up | Covered | 37252, 37253 | Both diagnosis and treatment follow-up covered |
| Type B aortic dissection with TEVAR, CT compromised or inconclusive | Covered | 37252, 37253, 33880, 33881 | Document CT inadequacy specifically |
| Infra-inguinal arterial disease with CO2 angiography, suboptimal imaging | Covered | 37252, 37253 | Requires documentation of: renal/health issue, CO2 use, suboptimal results |
| Coronary artery disease screening | Not Covered / Experimental | — | |
| Coronary vulnerable plaque diagnosis | Not Covered / Experimental | — | |
| Virtual histology IVUS, atherosclerotic plaque evaluation | Not Covered / Experimental | — | Specifically called out in policy |
| Aortic dissection diagnosis | Not Covered / Experimental | — | Distinct from covered TEVAR indication |
| Pulmonary hypertension diagnosis or evaluation | Not Covered / Experimental | 92997, 92998 | Related procedure codes listed but IVUS guidance not covered |
| Functional popliteal artery entrapment syndrome | Not Covered / Experimental | — | |
| Failing hemodialysis access graft interventions | Not Covered / Experimental | 36901, 36902, 36903 | High-volume access centers: flag this immediately |
| Carotid artery stenosis evaluation | Not Covered / Experimental | 37215–37218 | |
| Chronic venous obstruction or venous stenting | Not Covered / Experimental | 37238, 37239 | |
| Pulmonary artery angioplasty guidance | Not Covered / Experimental | 92997, 92998 | |
| Subclavian artery disease endovascular treatment guidance | Not Covered / Experimental | 0075T, 0076T | |
| Percutaneous mechanical thrombectomy for pulmonary embolism | Not Covered / Experimental | — | |
| Ilio-femoral vein stenting outcome prediction | Not Covered / Experimental | 37238, 37239 | |
| Carotid artery stenting outcome prediction | Not Covered / Experimental | 37215–37218 | |
| Non-coronary artery stenting | Not Covered / Experimental | 37236, 37237 | |
| TEVAR for blunt thoracic aortic injury | Not Covered / Experimental | 33880, 33881 | Different from covered type B dissection TEVAR |
| Lower extremity arterial occlusive disease (not meeting CO2 criteria) | Not Covered / Experimental | 37220–37235 | Must meet all three CO2 documentation criteria to be covered |
Aetna Intravascular Ultrasound Billing Guidelines and Action Items 2026
The coverage policy is live as of February 25, 2026. If you haven't already audited your workflows, do it this week.
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for CPT 92978, 92979, 37252, and 37253 billed alongside Aetna claims. Pull 90 days of claims. Map each one to the eight covered indications. Any claim that doesn't fit — flag it before it goes out. |
| 2 | Remove IVUS billing from hemodialysis access interventions for Aetna members. If your vascular access program bundles IVUS with CPT 36901, 36902, or 36903 for Aetna patients, stop now. These will deny. Communicate this to your interventionalists and update your charge capture templates. |
| 3 | Build documentation requirements for the CO2 angiography indication into your clinical workflow. The infra-inguinal arterial disease indication requires three documented elements: a documented health issue precluding contrast, use of CO2 angiography, and a finding that CO2 imaging was suboptimal. Missing any one of them kills the claim. Work with your medical director to create a documentation checklist before the procedure. |
| 4 | Verify prior authorization for all IVUS procedures in Aetna plans before scheduling. The CPB 0382 text doesn't specify prior auth requirements, but Aetna's plan-level requirements vary. Call to verify or check Aetna's prior auth tool — don't let a covered indication turn into a denial over a missed auth step. |
| 5 | Separate virtual histology IVUS from standard IVUS in your billing system. VH-IVUS for atherosclerotic plaque evaluation is experimental under this policy. If your cath lab performs both, make sure your coders can distinguish the two and aren't billing standard IVUS codes for VH-IVUS procedures. |
| 6 | Update your denial management queue. Add CPB 0382 as a filter for IVUS-related denials. When you see a denial tied to a non-covered indication, confirm it maps to the exclusion list before appealing — appeals on experimental indications rarely succeed without new clinical evidence. |
If your team has significant volume in vascular surgery or interventional radiology for Aetna members, loop in your compliance officer before February 25, 2026. The exclusion list is long and the documentation requirements for covered indications are specific. A billing consultant who works with IVUS-heavy practices can help you build the right workflows.
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Intravascular Ultrasound Under CPB 0382
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 37252 | CPT | Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention |
| 37253 | CPT | Intravascular ultrasound, each additional noncoronary vessel (add-on) |
| +92978 | CPT | Endoluminal imaging of coronary vessel or graft using IVUS or optical coherence tomography (add-on) |
| +92979 | CPT | Endoluminal imaging, each additional vessel (add-on) |
| C7569 | HCPCS | Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with endoluminal imaging |
Other CPT Codes Related to CPB 0382
These codes are listed in the policy as related procedures. IVUS coverage during these procedures depends on the covered indication criteria above.
| Code | Type | Description |
|---|---|---|
| 0075T–0076T | CPT | Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision |
| 33500–33530 | CPT | Surgery for coronary artery anomalies; venous grafting for coronary artery bypass |
| 33533 | CPT | Coronary artery bypass, using arterial graft(s) |
| 33534 | CPT | Coronary artery bypass, using arterial graft(s) |
| 33535 | CPT | Coronary artery bypass, using arterial graft(s) |
| 33536 | CPT | Coronary artery bypass, using arterial graft(s) |
| 33548 | CPT | Surgical ventricular restoration procedure, includes prosthetic patch |
| +33572 | CPT | Coronary endarterectomy, open, any method (add-on) |
| 33880 | CPT | Endovascular repair of descending thoracic aorta (e.g., aneurysm, pseudoaneurysm, dissection) |
| 33881 | CPT | Endovascular repair, not involving coverage of left subclavian artery origin |
| 36901 | CPT | Introduction of needle(s)/catheter(s), dialysis circuit, with diagnostic angiography |
| 36902 | CPT | Dialysis circuit with transluminal balloon angioplasty, peripheral dialysis segment |
| 36903 | CPT | Dialysis circuit with transcatheter placement of intravascular stent(s), peripheral dialysis segment |
| 37191 | CPT | Insertion of intravascular vena cava filter, endovascular approach |
| 37192 | CPT | Repositioning of intravascular vena cava filter, endovascular approach |
| 37193 | CPT | Retrieval of intravascular vena cava filter, endovascular approach |
| 37215 | CPT | Transcatheter placement of intravascular stent(s), cervical carotid artery, with embolic protection |
| 37216 | CPT | Transcatheter placement of intravascular stent(s), cervical carotid artery, without embolic protection |
| 37217 | CPT | Transcatheter placement of intravascular stent(s), intrathoracic common carotid or innominate artery, open |
| 37218 | CPT | Transcatheter placement of intravascular stent(s), intrathoracic common carotid or innominate artery, percutaneous |
| 37220 | CPT | Revascularization, endovascular, iliac artery |
| 37221 | CPT | Revascularization, endovascular, iliac artery, with stent |
| 37222 | CPT | Revascularization, endovascular, iliac artery, additional ipsilateral |
| 37223 | CPT | Revascularization, endovascular, iliac artery, additional contralateral |
| 37224 | CPT | Revascularization, endovascular, femoral/popliteal artery |
| 37225 | CPT | Revascularization, endovascular, femoral/popliteal artery, with atherectomy |
| 37226 | CPT | Revascularization, endovascular, femoral/popliteal artery, with stent |
| 37227 | CPT | Revascularization, endovascular, femoral/popliteal artery, with atherectomy and stent |
| 37228 | CPT | Revascularization, endovascular, tibial/peroneal artery |
| 37229 | CPT | Revascularization, endovascular, tibial/peroneal artery, with atherectomy |
| 37230 | CPT | Revascularization, endovascular, tibial/peroneal artery, with stent |
| 37231 | CPT | Revascularization, endovascular, tibial/peroneal artery, with atherectomy and stent |
| 37232 | CPT | Revascularization, endovascular, tibial/peroneal artery, additional |
| 37233 | CPT | Revascularization, endovascular, tibial/peroneal artery, additional with atherectomy |
| 37234 | CPT | Revascularization, endovascular, tibial/peroneal artery, additional with stent |
| 37235 | CPT | Revascularization, endovascular, tibial/peroneal artery, additional with atherectomy and stent |
| 37236 | CPT | Transcatheter placement of intravascular stent(s) (except lower extremity, cervical carotid, extracranial) |
| 37237 | CPT | Transcatheter stent placement, each additional artery (add-on) |
| 37238 | CPT | Transcatheter placement of intravascular stent(s), open or percutaneous, vein |
| 37239 | CPT | Transcatheter stent placement, each additional vein (add-on) |
| 61630 | CPT | Balloon angioplasty, intracranial, percutaneous |
| 61635 | CPT | Transcatheter placement of intravascular stent(s), intracranial |
| +92973 | CPT | Percutaneous transluminal coronary thrombectomy (add-on) |
| 92997 | CPT | Percutaneous transluminal pulmonary artery balloon angioplasty |
| 92998 | CPT | Percutaneous transluminal pulmonary artery balloon angioplasty, each additional vessel |
Key ICD-10-CM Diagnosis Codes
The policy references 214 ICD-10-CM codes. The full list is available in the source policy at CPB 0382 on PayerPolicy. Map your diagnosis codes to the eight covered indications — a valid CPT code paired with an unsupported diagnosis is still a denial.
Get the Full Picture for CPT 92978
Track this policy across versions, search 1,500+ policies by CPT code, and get real-time alerts when any payer changes coverage.