Lung Imaging: Selected Techniques — CPB 0581 | AETNA Coverage Update

Aetna modified CPB 0581 covering lung imaging techniques, effective February 25, 2026. Here's what billing teams need to know.

Aetna, a CVS Health company, updated its lung imaging coverage policy under CPB 0581 Aetna system. This revision clarifies which lung imaging techniques Aetna covers as medically necessary and which it classifies as experimental or unproven. The policy directly affects bronchoscopy codes (CPT 31622–31640), thoracic CT codes (CPT 71250–71275), and several newer technology codes including 0807T, 0808T, and 0877T–0880T. If your team bills lung imaging for Aetna members, read this before February 25, 2026.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Lung Imaging: Selected Techniques
Policy Code	CPB 0581
Change Type	Modified
Effective Date	February 25, 2026
Impact Level	Medium
Specialties Affected	Pulmonology, Thoracic Surgery, Interventional Radiology, Oncology
Key Action	Audit charge capture for 0807T, 0808T, 0877T–0880T, A9610, and C9791 — these are not covered under any current indication

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Aetna Lung Imaging Coverage Criteria and Medical Necessity Requirements 2026

The core of this Aetna lung imaging coverage policy is narrow. Aetna covers one lung imaging technique under the medical necessity standard: lung imaging fluorescence endoscopy, or LIFE.

LIFE is a bronchoscopic technique that uses fluorescent light to highlight abnormal bronchial tissue. Physicians use it to detect and biopsy pre-cancerous lesions, carcinomas in-situ, and early bronchogenic carcinomas. Aetna considers it medically necessary only for specific, well-defined patient populations.

To meet medical necessity under CPB 0581, a member must fall into one of these groups:

#	Covered Indication Copy
1	Known or previously diagnosed lung cancer — any member with an existing lung cancer diagnosis
2	Suspected lung cancer based on clinical symptoms — including positive sputum cytology, hemoptysis, infiltrates, or clinical signs of pneumonia not resolving within 30 days of treatment, persistent cough, or a positive X-ray
3	Previously resected Stage I lung cancer — members with no evidence of metastatic disease who are at risk for secondary disease

That third group is easy to overlook. A patient with a history of Stage I lung cancer — fully resected, no current metastasis — still qualifies if the clinical picture supports secondary disease risk. Document that clearly in the record before billing.

The covered bronchoscopy codes in this policy — CPT 31622 through 31640 and HCPCS C7567 — apply when LIFE is performed within these indications. Prior authorization requirements are not explicitly detailed in the CPB text, but given the clinical specificity of the coverage criteria, your team should verify authorization requirements before scheduling LIFE procedures for Aetna members.

Thoracic CT codes (CPT 71250, 71260, 71270, 71271, and 71275) appear in the policy as related codes, not as separately addressed covered services. Reimbursement for these codes follows standard Aetna radiology policy. Don't assume CPB 0581 expands or restricts those separately.

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Aetna Lung Imaging Exclusions and Non-Covered Indications

This is where the policy does most of its work — and where your denial risk lives.

Aetna classifies seven lung imaging modalities as experimental, investigational, or unproven under CPB 0581. "Experimental" is Aetna's cleanest denial trigger. If you submit a claim with one of these modalities and the indication doesn't match covered criteria, the denial is categorical, not discretionary.

Here's what Aetna will not cover:

1. CALIPER for interstitial lung disease. Computer-aided lung informatics for pathology evaluation and rating — the automated quantification tool used in ILD evaluation — is not covered. No CPT codes map directly to CALIPER as a standalone service in this policy, but if you're billing 0877T–0880T for augmentative CT analysis, that's the relevant code family.

2. Contrast-enhanced ultrasonography for lung cancer diagnosis. CPT 76978 and 76979 (targeted dynamic microbubble sonographic contrast characterization) are not covered for this indication. Neither are CPT 76376 and 76377 (3D rendering). These land in the "not covered" group regardless of clinical rationale.

3. LIFE for any indication outside Section I. If the member doesn't meet the three covered populations above, LIFE is experimental. This matters for edge cases — surveillance in high-risk smokers without current symptoms, for example, won't qualify unless the clinical criteria are met and documented.

4. 3D lung CT for bronchial anatomy evaluation. CPT 76376 and 76377 cover 3D rendering broadly, but Aetna specifically excludes this application for bronchial anatomy evaluation.

5. Point laser Raman spectroscopy combined with white light and auto-fluorescence bronchoscopy. No specific CPT code maps to this in the current data, but if your facility uses this technique, don't expect reimbursement from Aetna members.

6. XV LVAS pulmonary tissue ventilation analysis. CPT 0807T and 0808T are explicitly not covered. These codes cover software-based pulmonary tissue ventilation analysis using separately captured CT data. Aetna's position here is clear.

7. Xenon Xe-129 hyperpolarized gas (Xenoview) for lung ventilation evaluation. HCPCS A9610 (Xenon Xe-129 hyperpolarized gas, diagnostic, per study dose) and HCPCS C9791 (MRI with inhaled hyperpolarized xenon-129 contrast agent, chest) are not covered. This is a high-exposure item — Xenoview is a relatively new contrast agent, and billing teams at facilities offering hyperpolarized MRI need to flag this immediately.

Aetna also states explicitly: contrast agents are part of the underlying radiology imaging service and are not separately reimbursed. That applies directly to A9610 and C9791. Don't bill them as standalone line items.

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Coverage Indications at a Glance

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Aetna Lung Imaging Billing Guidelines and Action Items 2026

Act on these before the effective date of February 25, 2026.

1. Pull every claim billed with 0807T, 0808T, 0877T, 0878T, 0879T, or 0880T for Aetna members and stop billing them.
These codes are not covered under any indication in CPB 0581. If you've been submitting them, expect denials going forward. Review any outstanding claims now.

2. Flag A9610 and C9791 in your charge capture immediately.
Xenon Xe-129 hyperpolarized gas and the MRI administration code are not separately reimbursable. If your facility offers hyperpolarized lung MRI, your chargemaster likely has these active. Disable them for Aetna payer buckets before February 25, 2026 to avoid claim denial.

3. Verify LIFE claims against the three covered populations before submitting.
For every LIFE procedure billed to Aetna using CPT 31622–31640 or HCPCS C7567, confirm the member meets at least one of the three qualifying groups. Build a documentation checklist: known diagnosis, qualifying symptom, or prior Stage I resection with secondary risk. Attach it to the procedure order workflow.

4. Map your ICD-10-CM codes for LIFE claims to the right C34.x subcategories.
Aetna's policy includes 129 ICD-10 codes — mostly C34.x variants covering malignant neoplasms of the bronchus and lung by site and laterality, plus D and Z codes for related conditions. Use the most specific code available. Vague or unspecified codes invite medical necessity reviews. Check your encounter documentation against the C34.x hierarchy before billing.

5. Don't bill contrast agents separately on lung imaging claims.
Aetna states directly that contrast agents are part of the underlying imaging service. A9610 and C9791 are the two codes most at risk here. Separate line items for these will not be reimbursed and may trigger broader claim scrutiny.

6. Verify prior authorization for LIFE procedures before scheduling.
CPB 0581 doesn't specify a PA requirement, but Aetna's broader authorization policies often require PA for bronchoscopy procedures. Check the member's plan benefits before the procedure — not after. A PA gap is a clean claim denial with no good appeal path.

If your facility is using any of the experimental modalities — especially Xenoview or XV LVAS — and you're unsure how to handle payer mix exposure, talk to your compliance officer before the effective date.

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CPT, HCPCS, and ICD-10 Codes for Lung Imaging Under CPB 0581

Not Covered / Experimental CPT Codes

Covered CPT Codes (When Medical Necessity Criteria Are Met)

Not Covered / Experimental HCPCS Codes

Code	Description	Reason Copy
A9610	Xenon Xe-129 hyperpolarized gas, diagnostic, per study dose	Not covered — Xenoview for lung ventilation; not separately reimbursable as contrast agent
C9791	MRI with inhaled hyperpolarized xenon-129 contrast agent, chest	Not covered — Xenoview application; not separately reimbursable

Covered HCPCS Code (When Criteria Are Met)

Code	Description Copy
C7567	Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed, with transbronchial lung biopsy(s)

Key ICD-10-CM Diagnosis Codes

CPB 0581 includes 129 ICD-10-CM codes in total — primarily C34.x variants by laterality and site. Use the most specific available code from your encounter documentation. For the full code list, see the full policy at PayerPolicy.org.

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