TL;DR: Aetna, a CVS Health company, modified CPB 0796 governing near-infrared (NIR) spectroscopy coverage, effective November 21, 2025. The policy classifies virtually every NIR spectroscopy application as experimental, investigational, or unproven — and your billing team needs to know exactly which codes trigger automatic denials.
This update to the Aetna NIR spectroscopy coverage policy affects CPT codes 0640T, 0859T, and 0860T for noncontact NIR spectroscopy, as well as HCPCS S2068 for DIEP flap breast reconstruction monitoring and CPT 92978/92979 for intravascular ultrasound. If your practice bills any of these — especially in surgical, cardiac, psychiatric, or wound care settings — review your charge capture now.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Near-Infrared (NIR) Spectroscopy — CPB 0796 |
| Policy Code | CPB 0796 Aetna |
| Change Type | Modified |
| Effective Date | November 21, 2025 |
| Impact Level | High |
| Specialties Affected | Cardiac surgery, neurology, psychiatry, wound care, neonatology, thoracic surgery, plastic surgery, vascular surgery, ICU/critical care |
| Key Action | Audit all claims for CPT 0640T, 0859T, 0860T, 92978, 92979, and HCPCS S2068 billed to Aetna and flag for expected denial under current criteria |
Aetna Near-Infrared Spectroscopy Coverage Criteria and Medical Necessity Requirements 2025
The short version: Aetna does not consider NIR spectroscopy medically necessary for any indication in this policy. Every application listed in CPB 0796 falls under the experimental, investigational, or unproven designation. There are no covered indications to document toward.
This matters because physicians and OR teams often use NIR spectroscopy in clinical practice — particularly for cerebral perfusion monitoring during cardiac surgery and free flap viability checks after breast reconstruction. Widespread clinical use does not equal payer coverage. Aetna's position is that the clinical evidence base does not yet support routine reimbursement for these applications.
If your practice has been billing CPT 0640T (noncontact NIR spectroscopy for flap or wound measurement) or 0859T/0860T (noncontact NIR spectroscopy including ratio of total hemoglobin) expecting reimbursement, stop. These codes map directly to Aetna's experimental bucket under CPB 0796. Prior authorization won't fix a blanket experimental designation — there's no coverage pathway to authorize into.
The Aetna NIR spectroscopy coverage policy also extends to near-infrared intravascular ultrasound, specifically systems like the InfraReDx LipiScan™. CPT 92978 and 92979 (intravascular ultrasound of coronary vessels) are listed in the policy — and when billed in conjunction with NIR-IVUS systems for lipid-rich plaque detection or cholesterol-lowering therapy guidance, Aetna considers them not covered under this policy. Your billing team should confirm whether your cardiac cath lab's specific IVUS workflow triggers this exclusion.
Aetna Near-Infrared Spectroscopy Exclusions and Non-Covered Indications
The exclusion list in CPB 0796 is one of the longest you'll see in a single policy bulletin. Aetna calls out more than 35 specific clinical uses as experimental. These span nearly every specialty that has explored NIR spectroscopy in research settings.
Here's what's explicitly non-covered:
Neurology, Psychiatry, and Cognitive Health
Aetna excludes NIR spectroscopy for diagnosing bipolar disorder, unipolar disorder, schizophrenia, major depressive disorder, dysthymic disorder, obsessive compulsive disorder, panic disorder, psychotic disorder, and social anxiety disorder. Evaluating dementia, autism spectrum disorder, emotional states in affective disorders, depressive tendencies, post-stroke executive dysfunction, and gait disorders are all excluded. Monitoring post-operative cognitive dysfunction is also non-covered.
This is a broad sweep. If you work with any behavioral health or neurology group that has explored fNIRS (functional NIR spectroscopy) for psychiatric evaluation, those claims will not clear with Aetna.
Cardiac and Vascular Surgery
Monitoring cerebral perfusion during cardiac surgery is explicitly excluded. So is monitoring cerebral perfusion during non-cardiac surgery — including abdominal, orthopedic, and thoracic procedures. Detecting carotid or coronary vulnerable plaques, predicting cardiovascular outcomes in coronary artery disease, and detecting peripheral artery disease or diabetic foot disease are all non-covered.
This is the section that catches cardiac surgery programs off guard. Many centers use NIRS routinely for cerebral oximetry in cardiac bypass cases. Aetna's position is that clinical outcome data doesn't support coverage, regardless of clinical adoption.
Critical Care and Neonatal Settings
NIR spectroscopy in the ICU, NICU, or pediatric cardiac critical care unit is excluded. Detecting sepsis in neonates, using NIRS as a cerebral perfusion marker in sepsis patients with delirium, predicting neurodevelopmental outcomes in neonatal hypoxic ischemic encephalopathy, and guiding neonatal therapeutic hypothermia are all on the exclusion list.
Wound Care and Plastic Surgery
Evaluating lower extremity wounds, predicting wound healing via oxy-hemoglobin measurement, post-operative free flap monitoring, and DIEP flap viability monitoring for breast reconstruction are all experimental under this policy. HCPCS S2068 (DIEP flap or SIEP flap breast reconstruction) appears in the CPB — and the NIR monitoring often billed alongside it won't be separately reimbursable.
Oncology and Surgical Guidance
Intra-operative localization, lymph node sampling, and margin assessment for lung cancer are excluded. Non-contact NIR spectroscopy via SnapshotNIR for intra-operative wound assessment is also explicitly called out.
Other Excluded Uses
Assessing pain, evaluating anesthetic depth, evaluating mitochondrial disorders, guiding peripheral IV catheterization, assessing DVT risk, cochlear implant outcome prediction, restless legs syndrome treatment, and evaluating post-operative free flap viability round out the list.
The real issue here is scope. This policy covers enough clinical territory that any department experimenting with NIR-based monitoring — whether in research protocols or standard care — should assume Aetna will deny the associated claims.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| NIR spectroscopy as cerebral perfusion marker in sepsis with delirium | Experimental | ICD-10 A40.0–A41.9 | No coverage pathway |
| NIR spectroscopy for pain assessment | Experimental | — | No coverage pathway |
| Detecting carotid or coronary vulnerable plaques | Experimental | 92978, 92979 | Includes NIR-IVUS systems |
| Detecting sepsis in neonates | Experimental | ICD-10 A40.0–A41.9 | NICU use explicitly excluded |
| Detecting traumatic intracranial hematoma / TBI | Experimental | — | No coverage pathway |
| Diagnosing/managing developmental disorders | Experimental | — | No coverage pathway |
| Diagnosing mood disorders (bipolar, unipolar) | Experimental | 97129, 97130 | Psychiatric fNIRS excluded |
| Diagnosing schizophrenia | Experimental | — | No coverage pathway |
| Evaluating anesthetic depth | Experimental | — | No coverage pathway |
| Evaluating autism spectrum disorder | Experimental | — | No coverage pathway |
| Evaluating dementia | Experimental | — | No coverage pathway |
| Evaluating depressive tendencies | Experimental | 97129, 97130 | Cognitive therapy codes listed in policy |
| Evaluating emotional states/affective disorders/stress | Experimental | — | No coverage pathway |
| Evaluating gait disorders | Experimental | — | No coverage pathway |
| Evaluating lower extremity wounds / predicting wound healing | Experimental | 0640T, 0859T, 0860T | Includes oxy-hemoglobin measurement |
| Evaluating mitochondrial disorders | Experimental | — | No coverage pathway |
| Evaluating peripheral artery disease / diabetic foot | Experimental | — | No coverage pathway |
| Evaluating post-stroke executive dysfunction | Experimental | — | No coverage pathway |
| Evaluating psychiatric disorders (broad) | Experimental | 97129, 97130 | MDD, OCD, panic disorder, psychosis, social anxiety included |
| Evaluating risk of post-op DVT | Experimental | — | No coverage pathway |
| Guiding peripheral IV catheterization | Experimental | — | No coverage pathway |
| Cochlear implant outcome prediction / cortical plasticity | Experimental | 92584, 92626, 92627 | Audiology codes listed in policy |
| Lung cancer: intra-op localization, LN sampling, margin assessment | Experimental | ICD-10 C34.x range | No coverage pathway |
| Monitoring cerebral perfusion in acute neurological disorders | Experimental | — | Head injury, SAH, stroke, post-neurosurgery |
| Monitoring cerebral perfusion during cardiac surgery | Experimental | — | No coverage pathway |
| Monitoring cerebral perfusion during non-cardiac surgery | Experimental | — | Abdominal, orthopedic, thoracic, shoulder arthroscopy |
| Monitoring post-operative cognitive dysfunction | Experimental | 97129, 97130 | No coverage pathway |
| DIEP flap viability monitoring for breast reconstruction | Experimental | 0640T, 0859T, 0860T, S2068 | SFDI and noncontact NIR both excluded |
| Neonatal therapeutic hypothermia guidance | Experimental | — | NICU use excluded |
| Post-operative free flap monitoring | Experimental | 0640T, S2068 | No coverage pathway |
| Predicting cardiovascular outcomes in CAD | Experimental | 92978, 92979 | NIR-IVUS excluded |
| Predicting neurodevelopmental outcomes in neonatal HIE | Experimental | — | No coverage pathway |
| NIR-IVUS coronary imaging (e.g., InfraReDx LipiScan™) | Experimental | 92978, 92979 | All indications excluded |
| NIR spectroscopy via SFDI (e.g., Ox-Imager CS) | Experimental | 0640T, 0859T, 0860T | Vascular tissue compromise and all other uses excluded |
| Noncontact NIR spectroscopy (e.g., SnapshotNIR) for intra-op wound assessment | Experimental | 0640T, 0859T, 0860T | All indications excluded |
| ICU / NICU use (general) | Experimental | — | Explicitly excluded |
| Pediatric cardiac critical care | Experimental | — | Explicitly excluded |
| Treatment of restless legs syndrome | Experimental | — | No coverage pathway |
| Evaluating schizophrenia | Experimental | — | No coverage pathway |
Aetna Near-Infrared Spectroscopy Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit every open Aetna claim that includes CPT 0640T, 0859T, or 0860T. These three noncontact NIR spectroscopy codes are the highest-risk in this policy. Pull any claims submitted after November 21, 2025 and flag them. Expect denials. If they haven't been denied yet, they will be. |
| 2 | Review your cardiac surgery billing for CPT 92978 and 92979 linked to NIR-IVUS systems. If your cath lab uses the InfraReDx LipiScan™ or a similar NIR-IVUS device, document exactly what system is in use. Aetna's exclusion is device-specific in the policy language. When those codes appear alongside NIR-IVUS imaging for lipid plaque detection, the claim denial risk is high. |
| 3 | Remove HCPCS S2068 NIR monitoring add-ons from your DIEP flap charge capture. If your plastic surgery team has been appending NIR flap monitoring to DIEP reconstruction claims, that revenue stream is gone with Aetna under CPB 0796. The policy explicitly names DIEP flap viability monitoring as experimental. |
| 4 | Do not rely on prior authorization to unlock coverage. This is a blanket experimental designation, not a coverage criteria issue. Prior auth is a utilization management tool — it doesn't override an experimental classification. Submitting a prior auth request for CPT 0859T will not result in an approval. |
| 5 | Check your psychiatric and neurology workflows for any fNIRS billing. Codes 97129 and 97130 appear in this policy in connection with cognitive and psychiatric evaluation. If any provider in your group has been billing these alongside NIR-based cognitive assessment, review those claims against CPB 0796 billing guidelines before the next claims run. |
| 6 | Brief your clinical teams on the audiology and cochlear implant carve-outs. CPT 92584, 92626, and 92627 appear in this policy related to cochlear implant outcome prediction using NIR. If your ENT or audiology department uses any NIR-based cortical mapping tool, those claims won't clear with Aetna. |
| 7 | Document your technology clearly in operative notes. When providers use optical or spectroscopy-based monitoring tools, the device name matters. Aetna's exclusions reference specific technologies like the Ox-Imager CS and SnapshotNIR. Ambiguous documentation creates denials that are harder to appeal. Clear documentation makes it easier to determine whether a claim even belongs in the Aetna billing queue. |
If your organization has a significant volume of NIR-related procedures and Aetna is a major payer in your mix, loop in your compliance officer before your next billing cycle. The breadth of this policy is wide enough that an internal claim audit may surface exposure you weren't tracking.
| 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 Near-Infrared Spectroscopy Under CPB 0796
Not Covered / Experimental CPT Codes
| Code | Type | Description | Notes |
|---|---|---|---|
| 0640T | CPT | Noncontact near-infrared spectroscopy studies of flap or wound (e.g., for measurement of deoxyhemoglobin, oxyhemoglobin) | Experimental for all indications including wound and flap monitoring |
| 0859T | CPT | Noncontact near-infrared spectroscopy (e.g., for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of total hemoglobin) | Experimental — all indications; includes Ox-Imager CS and SnapshotNIR |
| 0860T | CPT | Noncontact near-infrared spectroscopy (e.g., for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of total hemoglobin) | Experimental — all indications |
| +92978 | CPT | Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or therapeutic intervention | Experimental when paired with NIR-IVUS for lipid plaque detection or cholesterol-lowering guidance |
| +92979 | CPT | Each additional vessel (intravascular ultrasound, coronary) | Experimental — same exclusion as 92978 |
Other CPT Codes Referenced in CPB 0796
| Code | Type | Description | Context |
|---|---|---|---|
| 92584 | CPT | Electrocochleography | Listed in policy for cochlear implant outcome/cortical plasticity indication |
| 92626 | CPT | Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status | Listed in policy — cochlear implant NIR use excluded |
| 92627 | CPT | Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status | Listed in policy — cochlear implant NIR use excluded |
| 97129 | CPT | Therapeutic interventions focused on cognitive function (e.g., attention, memory, reasoning, executive function) | Listed in policy context of psychiatric/cognitive NIR evaluation |
| 97130 | CPT | Therapeutic interventions focused on cognitive function — each additional 15 minutes | Listed in policy context of psychiatric/cognitive NIR evaluation |
Not Covered HCPCS Codes
| Code | Type | Description | Notes |
|---|---|---|---|
| S2068 | HCPCS | Breast reconstruction with deep inferior epigastric perforator (DIEP) flap or superficial inferior epigastric artery (SIEA) flap | Listed in context of DIEP flap NIR viability monitoring — experimental |
Key ICD-10-CM Diagnosis Codes in CPB 0796
| Code Range | Description | Context in Policy |
|---|---|---|
| A40.0–A41.9 | Sepsis | NIR as cerebral perfusion marker in sepsis with delirium; neonatal sepsis detection |
| C34.0–C34.69 | Malignant neoplasm of bronchus and lung | Intra-operative lung cancer localization, LN sampling, margin assessment |
Note: The full ICD-10 code list in CPB 0796 contains 395 codes. The ranges above represent the primary diagnosis groupings tied to specific excluded indications named in the policy summary. Pull the full code list from the Aetna CPB 0796 source document for complete diagnosis-level mapping.
Get the Full Picture for CPT 92978
Track this policy across versions, search 1,500+ policies by CPT code, and get real-time alerts when any payer changes coverage.