AcuTect Scintigraphic Imaging for Detection of Lower Limb Deep Vein Thrombosis — CPB 0414 | AETNA Coverage Update

Aetna modified CPB 0414 covering AcuTect scintigraphic imaging for lower limb deep vein thrombosis, effective September 26, 2025. CPT 78456 is explicitly not covered. Here's what billing teams need to do.

Aetna, a CVS Health company, updated Clinical Policy Bulletin 0414 on September 26, 2025. This coverage policy addresses AcuTect scintigraphic imaging—technetium Tc-99m apcitide (HCPCS A9504) imaging—used to detect lower limb deep vein thrombosis (DVT). CPT 78456, the code for acute venous thrombosis imaging with a peptide, sits in the "not covered" column. If your vascular, nuclear medicine, or radiology team bills for DVT imaging, this update directly affects your claim submission and denial risk.

Quick-Reference Table

Aetna AcuTect Scintigraphic Imaging Coverage Criteria and Medical Necessity Requirements 2025

The core issue with CPB 0414 Aetna is this: AcuTect imaging—the peptide-based scintigraphic scan coded as CPT 78456—does not meet Aetna's medical necessity standard for lower limb DVT detection. Aetna does not cover CPT 78456 for the indications listed in this bulletin.

This is not a gray-area policy. CPT 78456 (acute venous thrombosis imaging, peptide) is explicitly categorized as "not covered for indications listed in the CPB." That's a hard denial trigger, not a prior authorization situation where documentation can save the claim.

Aetna's coverage policy does recognize DVT diagnosis as a legitimate clinical need. The payer covers related venography and venous thrombosis imaging under separate codes—specifically CPT 75820, 75822, 78457, and 78458, along with HCPCS A9504. These are the acceptable pathways for DVT imaging reimbursement under this policy.

If you're wondering whether prior authorization could open the door for CPT 78456, the answer is no. When Aetna categorically excludes a service from coverage, prior auth doesn't apply—there's nothing to authorize. Save your team's time and don't submit PA requests for this code under DVT indications.

The 201 ICD-10-CM diagnosis codes tied to this policy span the full range of DVT and venous thrombosis presentations—phlebitis and thrombophlebitis codes from I80.10 through I80.9, and venous embolism and thrombosis codes from I82.0 through the I82 range. These diagnosis codes pair with the covered venography and venous thrombosis imaging codes, not with CPT 78456.

Aetna AcuTect Scintigraphic Imaging Exclusions and Non-Covered Indications

CPT 78456 is the only code in this policy explicitly designated as not covered. The description is "acute venous thrombosis imaging, peptide"—this is the AcuTect scan itself.

AcuTect uses technetium Tc-99m apcitide (A9504) as the imaging agent. The scan works by binding to activated platelets at clot sites. Aetna's position is that this technology does not clear its medical necessity bar for lower limb DVT detection.

This mirrors a broader pattern in payer policy. Newer peptide-based and molecular imaging approaches often sit in coverage limbo while payers wait for larger clinical trial data. Aetna isn't alone in this position—several major payers have held similar stances on CPT 78456 for years.

The real risk here isn't accidental billing. It's systematic billing. If a nuclear medicine or vascular lab has CPT 78456 in its charge capture as a default DVT imaging option, every Aetna claim for that code will deny. Audit your charge capture now.

Coverage Indications at a Glance

Aetna DVT Imaging Billing Guidelines and Action Items 2025

The effective date is September 26, 2025. That's your line in the sand. Here's what to do before and after that date.

If your facility does significant volume of nuclear medicine DVT studies and you're unsure how this affects your specific payer mix, talk to your compliance officer before September 26, 2025.

CPT, HCPCS, and ICD-10 Codes for AcuTect DVT Imaging Under CPB 0414

Not Covered CPT Codes

Related HCPCS Code

Key ICD-10-CM Diagnosis Codes

These 201 diagnosis codes define the DVT and venous thrombosis indications covered by CPB 0414. They pair with the covered imaging codes—not with CPT 78456.

The full ICD-10-CM list runs 201 codes deep. Pull the complete list directly from CPB 0414 on the Aetna policy portal and validate your diagnosis coding against it. Using a non-listed ICD-10 code with any DVT imaging service creates medical necessity documentation risk, even for the covered CPT codes.