Intra-vascular Optical Coherence Tomography — CPB 0829 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0829 for intra-vascular optical coherence tomography (OCT), effective December 5, 2025. Every indication is non-covered — and your team needs to know exactly which codes to expect denials on.

Aetna's intra-vascular OCT coverage policy under CPB 0829 Aetna system classifies this technology as experimental, investigational, or unproven across the board. That means CPT codes 92978, 92979, and the newer Category III codes 0984T through 0987T all land in denial territory. If your cardiology or vascular team bills OCT-guided procedures, this update deserves your attention before December 5, 2025.

Quick-Reference Table

Aetna Intra-Vascular OCT Coverage Criteria and Medical Necessity Requirements 2025

Here's the blunt version of this coverage policy: there are no covered indications. Aetna does not recognize medical necessity for intra-vascular OCT under any clinical scenario. This is a complete exclusion policy, not a narrowed-criteria policy.

The Aetna intra-vascular OCT billing situation is different from a policy where you meet criteria and get paid. There is no criteria to meet. Aetna's position is that the evidence base for this technology is insufficient — full stop.

This affects prior authorization workflows too. Don't waste time submitting prior auth requests hoping for approval. Aetna will not authorize intra-vascular OCT because the procedure doesn't meet medical necessity under this policy. If a physician in your group is ordering OCT guidance for coronary stent placement and expecting reimbursement, that expectation needs to be corrected now.

The primary codes caught by this denial wall are CPT 92978 (endoluminal imaging of coronary vessel or graft using intravascular ultrasound or optical coherence tomography, initial vessel) and CPT 92979 (each additional vessel). The Category III codes — 0984T, 0985T, 0986T, and 0987T — cover OCT of cerebral vessels and also carry non-covered status. None of these generate reimbursement from Aetna.

Aetna Intra-Vascular OCT Exclusions and Non-Covered Indications

The exclusion list in CPB 0829 is long. Aetna explicitly calls out 19 separate indications — each one denied as experimental, investigational, or unproven. That list covers the major clinical scenarios your interventional cardiologists, neurologists, and pulmonologists use to justify OCT.

This isn't a case of vague policy language. Aetna names each indication individually. That specificity makes claim denial more likely when any of these diagnosis codes appear on an OCT claim.

The 19 non-covered indications under CPB 0829 are:

If your team sees any of the above as a documented clinical rationale on an OCT order, expect a denial. There is no appeal path based on medical necessity under this policy — Aetna's position is that the evidence simply isn't there yet.

Coverage Indications at a Glance

Aetna Intra-Vascular OCT Billing Guidelines and Action Items 2025

The billing guidelines here are clear in one direction: stop billing these codes expecting payment from Aetna. Here's what your team should do before December 5, 2025.

If you're unsure how this policy interacts with your specific Aetna contract or plan mix, talk to your compliance officer before December 5, 2025. Commercial plan terms can vary, and what applies to the CPB may interact differently with specific employer plan exclusions.

CPT, HCPCS, and ICD-10 Codes for Intra-Vascular OCT Under CPB 0829

Not Covered / Experimental CPT Codes

These codes are explicitly listed as not covered for the indications in CPB 0829.

Key ICD-10-CM Diagnosis Codes

These diagnosis codes appear in CPB 0829 and represent the clinical scenarios Aetna specifically identifies as non-covered for intra-vascular OCT billing.

The full policy lists 191 ICD-10-CM codes. The codes above represent the key diagnostic categories. Review the full CPB 0829 policy at app.payerpolicy.org/p/aetna/0829 for the complete code set.