Magnetic Resonance Imaging of the Cardiovascular System - Cardiac MRI — CPB 0520 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0520 governing cardiac MRI coverage, effective September 26, 2025. Here's what billing teams need to know before submitting claims.

Aetna's updated cardiac MRI coverage policy under CPB 0520 in the Aetna system directly affects CPT codes 75557, 75559, 75561, 75563, and 75565. The policy aligns Aetna's medical necessity criteria with guidelines from the American College of Cardiology Foundation, the American College of Radiology, and the American Heart Association. If your cardiology or radiology practice bills these codes for Aetna members, review your prior authorization workflows and documentation standards now — before September 26, 2025.

Quick-Reference Table

Aetna Cardiac MRI Coverage Criteria and Medical Necessity Requirements 2025

Aetna's cardiac MRI coverage policy under CPB 0520 considers MRI of the cardiovascular system medically necessary for specific indications. Those indications align with published guidelines from the American College of Cardiology Foundation (ACCF), the American College of Radiology (ACR), and the American Heart Association (AHA).

The five core cardiac MRI CPT codes covered when selection criteria are met are:

Coverage for each of these codes depends on documented medical necessity tied to a covered clinical indication. Aetna does not cover cardiac MRI as a routine screening tool or as a substitute for other imaging when a lower-cost modality is appropriate and clinically equivalent.

Prior authorization is common for advanced cardiac imaging under Aetna plans. Check your specific plan contracts — many Aetna commercial and Medicare Advantage products require prior auth before cardiac MRI billing. Submitting CPT 75561 or 75563 without prior authorization on plans that require it is one of the fastest paths to a claim denial.

The medical necessity standard here is not new — Aetna has long followed ACCF/AHA appropriateness criteria. What matters with this modification is whether Aetna updated the specific covered indications, exclusion language, or documentation requirements. Review the full CPB 0520 document at the Aetna source to catch any language changes that affect your patient population.

Aetna Cardiac MRI Exclusions and Non-Covered Indications

The policy data does not explicitly list exclusions in the summary provided. That said, the structure of CPB 0520 — where coverage is contingent on "selection criteria are met" — means any cardiac MRI billed outside a listed covered indication is effectively not covered.

The "Other CPT codes related to the CPB" group in this policy includes thoracic CT (71250–71270), chest MRI (71550–71552), nuclear medicine cardiovascular imaging (78414 and above), and breast MRI (77046–77047). These codes are referenced within the policy's scope but do not carry the same covered-when-criteria-met status as the five core cardiac MRI codes. Billing these as substitutes for cardiac MRI — or assuming coverage transfers — is a mistake your team should avoid.

If a patient's clinical scenario doesn't map cleanly to a covered indication under CPB 0520, your physician needs to document why cardiac MRI was chosen over alternative imaging. Aetna reviewers will look at that record during a claim review or audit.

Coverage Indications at a Glance

The policy ties coverage to ACCF/AHA/ACR guidelines. The table below reflects the structure of CPB 0520 based on the available policy data. For the full list of covered indications, review the complete policy at Aetna's source.

Aetna Cardiac MRI Billing Guidelines and Action Items 2025

Here's what your billing team and revenue cycle staff should do before September 26, 2025.

CPT, HCPCS, and ICD-10 Codes for Cardiac MRI Under CPB 0520

Covered CPT Codes (When Selection Criteria Are Met)

These are the five primary cardiac MRI CPT codes that Aetna covers under CPB 0520 when medical necessity criteria are satisfied.

Other CPT Codes Referenced in CPB 0520

These codes are related to the policy but fall under separate coverage criteria. They are not automatically covered under the cardiac MRI indications.

The full policy references 93 additional CPT codes and 313 ICD-10-CM codes. Review the complete CPB 0520 document at the Aetna source for the full code set.

Key ICD-10-CM Diagnosis Codes

The policy references 313 ICD-10-CM codes. The provided data includes the full set within the policy document. Pull the complete list from the CPB 0520 source to map your cardiac diagnoses to covered indications before September 26, 2025. Your ICD-10 code selection is not just a diagnosis label — it's the primary driver of whether Aetna approves or denies a cardiac MRI claim under this coverage policy.