TL;DR: Aetna, a CVS Health company, modified CPB 0692 effective October 18, 2025, confirming that acoustic heart sound recording, computer analysis, and related cardiac diagnostic technologies — including CPT 0716T and 0962T — are non-covered as experimental and investigational.
This update to CPB 0692 Aetna's acoustic heart sound recording coverage policy explicitly calls out the SENSORA AI Heart Disease Detection Platform by name. That's a notable addition. If your cardiology or internal medicine billing team has been testing reimbursement pathways for AI-assisted cardiac diagnostics, this policy slams the door. CPT 0716T, CPT 0962T, and HCPCS S3902 are all listed as not covered. Here's what changes for billing teams.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Acoustic Heart Sound Recording and Computer Analysis — CPB 0692 |
| Policy Code | CPB 0692 |
| Change Type | Modified |
| Effective Date | October 18, 2025 |
| Impact Level | Medium — high exposure for cardiology practices adopting AI diagnostic tools |
| Specialties Affected | Cardiology, Internal Medicine, Primary Care, Revenue Cycle |
| Key Action | Remove CPT 0716T, 0962T, and HCPCS S3902 from charge capture and update denial management workflows before October 18, 2025 |
Aetna Acoustic Heart Sound Recording Coverage Criteria and Medical Necessity Requirements 2025
Aetna's acoustic heart sound recording coverage policy under CPB 0692 is unambiguous: there are no covered indications. This isn't a policy with a narrow approval pathway. Aetna does not recognize medical necessity for any form of acoustic heart sound recording, computer analysis, or interpretation.
That means CPT 0716T — cardiac acoustic waveform recording with automated analysis for coronary artery disease — gets no coverage regardless of diagnosis. CPT 0962T — assistive algorithmic analysis of acoustic and electrocardiogram recording for cardiac detection — gets the same treatment. Neither passes the medical necessity bar under this coverage policy.
The clinical scope of CPB 0692 covers a wide range of cardiac sound and motion technologies. That list includes auscultation jackets, ballistocardiography, optical vibrocardiography, phonocardiography, and vectorcardiography. All are classified as experimental, investigational, or unproven. None have a reimbursement pathway under Aetna plans.
Prior authorization won't help here. This isn't a situation where submitting a prior auth request and documenting clinical justification will reverse the outcome. These services are excluded at the coverage level, not just flagged for clinical review.
If you're unsure how this applies to your payer mix or contract terms, talk to your compliance officer before the October 18 effective date.
Aetna Acoustic Heart Sound Recording Exclusions and Non-Covered Indications
The October 2025 update to CPB 0692 adds a specific named exclusion that wasn't in earlier versions: the SENSORA AI Heart Disease Detection Platform. Aetna explicitly calls it out for detection of atrial fibrillation, cardiac murmurs, reduced ejection fraction, and valvular heart disease. All of those indications are non-covered under this policy.
This is the part that matters for forward-looking billing teams. Vendors selling AI cardiac screening tools often market them as compatible with existing CPT codes. CPT 0962T was introduced for exactly this type of algorithmic acoustic and ECG analysis. Aetna's position is that the evidence doesn't support coverage — and now they've put a specific commercial platform on the record.
The full list of non-covered technologies under CPB 0692:
| # | Excluded Procedure |
|---|---|
| 1 | Acoustic heart sound recording, computer analysis, and interpretation (CPT 0716T, CPT 0962T) |
| 2 | Auscultation jacket |
| 3 | Ballistocardiography (HCPCS S3902) |
| 4 | Optical vibrocardiography |
| 5 | Phonocardiography |
| 6 | Vectorcardiography |
| 7 | SENSORA AI Heart Disease Detection Platform |
None of these have a covered indication under any ICD-10 code, including the full range of circulatory system diagnoses under I00–I99.9, cardiac murmurs under R01.0–R01.2, or cardiovascular screening encounter Z13.6.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Acoustic heart sound recording and computer analysis | Not Covered — Experimental | CPT 0716T, CPT 0962T | No covered pathway; not subject to prior auth override |
| Cardiac acoustic waveform recording for CAD detection | Not Covered — Experimental | CPT 0716T | Explicitly non-covered regardless of diagnosis |
| Algorithmic acoustic + ECG analysis for cardiac detection | Not Covered — Experimental | CPT 0962T | Covers AI-assisted analysis tools including named platforms |
| SENSORA AI Heart Disease Detection Platform | Not Covered — Experimental | CPT 0962T | New named exclusion added in October 2025 update |
| Ballistocardiography | Not Covered — Experimental | HCPCS S3902 | Long-standing exclusion; reaffirmed in this update |
| Auscultation jacket | Not Covered — Experimental | None listed | Non-covered; no CPT code mapped |
| Optical vibrocardiography | Not Covered — Experimental | None listed | Non-covered; no CPT code mapped |
| Phonocardiography | Not Covered — Experimental | None listed | Non-covered; no CPT code mapped |
| Vectorcardiography | Not Covered — Experimental | None listed | Non-covered; no CPT code mapped |
| Atrial fibrillation detection via acoustic analysis | Not Covered — Experimental | CPT 0962T | Specifically named in SENSORA exclusion language |
| Cardiac murmur detection via acoustic analysis | Not Covered — Experimental | CPT 0962T | Specifically named in SENSORA exclusion language |
| Reduced ejection fraction detection via acoustic analysis | Not Covered — Experimental | CPT 0962T | Specifically named in SENSORA exclusion language |
| Valvular heart disease detection via acoustic analysis | Not Covered — Experimental | CPT 0962T | Specifically named in SENSORA exclusion language |
Aetna Acoustic Heart Sound Recording Billing Guidelines and Action Items 2025
The real issue with a policy like this isn't the individual claim denials. It's the downstream problem: practices piloting new AI cardiac tools sometimes build workflows assuming reimbursement will follow adoption. CPB 0692 tells you it won't — at least not with Aetna. Here's what your billing team needs to do now.
| # | Action Item |
|---|---|
| 1 | Remove CPT 0716T and CPT 0962T from charge capture before October 18, 2025. If either code lives in your cardiology superbill or EHR charge router, flag them as non-covered for Aetna plans. Every claim you submit will deny. |
| 2 | Audit outstanding claims for CPT 0716T and CPT 0962T now. Pull any claims submitted to Aetna in the past 12 months for these codes. If any went through without denial, expect recoupment requests. Get ahead of that conversation. |
| 3 | Update your denial management queue filters. Add CPT 0716T, 0962T, and HCPCS S3902 to your payer-specific denial tracking for Aetna. These won't be overturned on appeal — the policy language is explicit. Don't burn staff time working denials that have no recovery path. |
| 4 | Inform physicians considering SENSORA or similar AI cardiac platforms. The clinical appeal is real — AI-assisted auscultation and cardiac screening tools are genuinely interesting technology. But Aetna has named the SENSORA platform specifically as non-covered. If your practice is in a contract or pilot with a vendor using CPT 0962T as the billing vehicle, the reimbursement assumption is wrong for Aetna-covered patients. |
| 5 | Check your other major payers for similar acoustic heart sound billing guidelines. Aetna's position here isn't unique — most major commercial payers treat these technologies as experimental. But CPB 0692 is the specific Aetna policy. Other payers may have different effective dates, different named exclusions, or different code lists. Don't assume Cigna or UnitedHealthcare coverage mirrors this one without checking their own policy language. |
| 6 | Flag Z13.6 cardiovascular screening encounters. If your practice uses Z13.6 as a diagnosis code paired with any acoustic or AI cardiac technology for preventive screening, that combination will deny under Aetna. This is a common pathway for wellness-focused cardiac screening programs. It doesn't work here. |
| 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 Acoustic Heart Sound Recording Under CPB 0692
Not Covered / Experimental CPT and HCPCS Codes
| Code | Type | Description | Status |
|---|---|---|---|
| 0716T | CPT | Cardiac acoustic waveform recording with automated analysis and generation of coronary artery disease risk score | Not Covered — Experimental/Investigational |
| 0962T | CPT | Assistive algorithmic analysis of acoustic and electrocardiogram recording for detection of cardiac dysfunction | Not Covered — Experimental/Investigational |
| S3902 | HCPCS | Ballistocardiogram | Not Covered — Experimental/Investigational |
Key ICD-10-CM Diagnosis Codes Referenced in CPB 0692
These codes appear in the policy's code table. They represent the diagnostic categories Aetna associates with these services. None create a covered indication — the non-coverage is absolute for these technologies regardless of diagnosis.
| Code | Description |
|---|---|
| I00–I99.9 | Diseases of the circulatory system |
| R00.8 | Other abnormalities of heart beat |
| R00.9 | Unspecified abnormalities of heart beat |
| R01.0 | Benign and innocent cardiac murmurs |
| R01.1 | Cardiac murmur, unspecified |
| R01.2 | Other cardiac sounds |
| R09.89 | Other specified symptoms and signs involving the circulatory and respiratory systems |
| R09.A0 | Other specified symptoms and signs involving the circulatory and respiratory systems |
| R09.A1 | Other specified symptoms and signs involving the circulatory and respiratory systems |
| R09.A2 | Other specified symptoms and signs involving the circulatory and respiratory systems |
| R09.A9 | Other specified symptoms and signs involving the circulatory and respiratory systems |
| R93.1 | Abnormal findings on diagnostic imaging of heart and coronary circulation |
| R93.811–R93.89 | Abnormal findings on diagnostic imaging of other specified body structures |
| R94.30 | Abnormal results of cardiovascular function studies |
| R94.31 | Abnormal results of cardiovascular function studies |
| R94.32 | Abnormal results of cardiovascular function studies |
| R94.33 | Abnormal results of cardiovascular function studies |
| R94.34 | Abnormal results of cardiovascular function studies |
| R94.35 | Abnormal results of cardiovascular function studies |
| R94.36 | Abnormal results of cardiovascular function studies |
| R94.37 | Abnormal results of cardiovascular function studies |
| R94.38 | Abnormal results of cardiovascular function studies |
| R94.39 | Abnormal results of cardiovascular function studies |
| Z13.6 | Encounter for screening for cardiovascular disorders |
One note on how to read this code list: the presence of these ICD-10 codes in the policy doesn't signal a coverage pathway. Aetna includes them to define the clinical scope of the policy — these are the conditions for which someone might order these services. The policy's position is the same for all of them: not covered.
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