Acoustic Heart Sound Recording and Computer Analysis — CPB 0692 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0692 covering acoustic heart sound recording and computer analysis, effective October 18, 2025. CPT 0716T and 0962T are explicitly non-covered under this Aetna acoustic heart sound coverage policy — and that includes the SENSORA AI platform. Here's what billing teams need to act on now.

Quick-Reference Table

Aetna Acoustic Heart Sound Coverage Policy: Coverage Criteria and Medical Necessity Requirements 2025

CPB 0692 in the Aetna system covers a cluster of cardiac diagnostic technologies. These include acoustic heart sound recording with computer analysis, phonocardiography, ballistocardiography, vectorcardiography, optical vibrocardiography, and the auscultation jacket.

Every single one of them is non-covered. Aetna does not consider any of these technologies to meet medical necessity standards. The payer's position is that the clinical evidence does not establish their effectiveness — full stop.

This is not a coverage policy with a covered subset and a non-covered subset. There is no path to reimbursement for these services under Aetna plans. Prior authorization will not unlock coverage here — these services are classified as experimental, investigational, or unproven, which means prior auth isn't the barrier. The technology itself fails Aetna's evidence threshold.

If your billing team has been submitting CPT 0716T (cardiac acoustic waveform recording with automated analysis) or CPT 0962T (assistive algorithmic analysis of acoustic and electrocardiogram recording) expecting any coverage, this policy is your answer. The effective date of October 18, 2025 formalizes the updated language, but the non-covered status is not new — this is a modification to an existing bulletin, not a reversal of prior coverage.

Aetna Acoustic Heart Sound Exclusions and Non-Covered Indications

The most notable addition in the modified CPB 0692 is the explicit callout of the SENSORA AI Heart Disease Detection Platform. Aetna now names this platform directly as experimental and unproven for detecting cardiac dysfunction, including atrial fibrillation, cardiac murmurs, reduced ejection fraction, and valvular heart disease.

This matters. When Aetna starts naming specific vendor platforms in a Clinical Policy Bulletin, it signals that claims for those platforms have been coming in — and they want to shut the door clearly. If anyone on your team has been billing for SENSORA AI-based analysis under CPT 0962T, expect claim denial on any outstanding or future Aetna claims.

The full list of non-covered interventions under CPB 0692 is:

None of these have covered indications. The ICD-10 diagnosis codes listed in the policy — including codes across the I00–I99.9 circulatory disease range, murmur codes R01.0 through R01.2, and cardiac screening code Z13.6 — appear in the bulletin as context for the scope of the policy. They do not create a pathway to coverage. Aetna lists them to define what the policy addresses, not to authorize claims.

Coverage Indications at a Glance

Aetna Acoustic Heart Sound Billing Guidelines and Action Items 2025

The policy effective date is October 18, 2025. Here's what your billing team should do before and after that date.

1. Pull CPT 0716T and 0962T from your Aetna charge capture now.
These codes have no covered indication under Aetna plans. If they're in your charge master or superbill for cardiology, flag them with a non-covered designation for Aetna payers. Don't wait for a claim denial to trigger the update.

2. Audit open claims for CPT 0716T and 0962T submitted to Aetna.
Run a claims report for the past 12 months. Look for any submissions of 0716T or 0962T billed to Aetna. If any are still in pending status, expect denial. If any were paid in error, prepare for potential recoupment — Aetna can and does look back when a policy modification clarifies non-covered status.

3. Check your HCPCS S3902 billing practices.
Ballistocardiography billed under S3902 is also explicitly non-covered. This code doesn't come up often, but if your practice or a referring partner uses it for cardiac diagnostics, it will not pay under Aetna plans. Update your payer-specific edits for S3902 accordingly.

4. Flag any SENSORA AI platform contracts or agreements.
If your cardiology group or health system has a contract or pilot arrangement with SENSORA, your revenue cycle team needs to know that Aetna won't reimburse services tied to that platform. This is now explicitly named in CPB 0692. Talk to your compliance officer before billing Aetna for any SENSORA-generated analysis.

5. Brief your cardiology and primary care physicians on the scope of this policy.
The ICD-10 codes in scope here cover nearly the entire circulatory disease chapter (I00–I99.9) plus cardiac murmur codes (R01.0–R01.2) and cardiovascular screening (Z13.6). Physicians ordering these acoustic diagnostic studies against Aetna patients should know there is no reimbursement path — regardless of diagnosis.

6. Don't rely on prior authorization as a workaround.
Some billing teams try to obtain prior auth for experimental services as a coverage strategy. It won't work here. Aetna's classification of these services as experimental and unproven means prior authorization is not a route to approval. Save your team the administrative time.

CPT, HCPCS, and ICD-10 Codes for Acoustic Heart Sound Recording Under CPB 0692

Not Covered / Experimental CPT Codes

Not Covered / Experimental HCPCS Codes

Key ICD-10-CM Diagnosis Codes Referenced in CPB 0692

These codes define the scope of the policy. They do not create covered indications.

The Real Issue With This Policy

CPT 0716T and 0962T are relatively new Category III codes. They were designed for emerging cardiac acoustic technologies — the kind that AI-driven platforms like SENSORA are built around. The problem is that Category III codes often move faster than payer evidence reviews.

Aetna's position is consistent with most major commercial payers here. None of the big four — Aetna, Cigna, UnitedHealthcare, or CMS — currently covers acoustic heart sound recording with computer analysis as a standard of care. That doesn't mean the technology won't get there. It means your billing team should not be submitting these codes expecting payment now.

If you're seeing pressure from physicians or vendors to bill these services, the answer is the same: document the non-covered status, provide patients with an Advance Beneficiary Notice equivalent for commercial plans (an ABN-style financial responsibility agreement), and don't submit the claim to Aetna without that documentation in place. Your compliance officer should review your practice's consent and financial notification process for non-covered cardiac diagnostic services.

The broader billing guidelines here are simple: these codes don't pay under Aetna. Plan accordingly.