Aetna modified CPB 0846 for near-infrared vascular imaging and near-infrared fluorescence imaging, effective December 6, 2025. Every indication in this policy is classified as experimental, investigational, or unproven — meaning zero covered claims for HCPCS C9756 or CPT 0961T under Aetna.
Aetna, a CVS Health company, updated Clinical Policy Bulletin 0846 to reflect its current position on near-infrared vascular imaging and near-infrared fluorescence (NIRF) imaging across a wide range of surgical and diagnostic indications. The policy covers CPT 0961T (short-wave infrared imaging), HCPCS C9756 (intraoperative near-infrared fluorescence lymphatic mapping), and a cluster of related laparoscopic procedure codes. If your team bills these services to Aetna members, this coverage policy is a blanket denial waiting to happen.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Near-Infrared Vascular Imaging and Near-Infrared Fluorescence Imaging |
| Policy Code | CPB 0846 |
| Change Type | Modified |
| Effective Date | December 6, 2025 |
| Impact Level | High |
| Specialties Affected | General surgery, oncology, gynecology, urology, vascular surgery, neurosurgery, transplant surgery |
| Key Action | Flag CPT 0961T and HCPCS C9756 in your charge capture as non-covered under Aetna before submitting any claims with these codes |
Aetna Near-Infrared Imaging Coverage Criteria and Medical Necessity Requirements 2025
Here is the short version of the Aetna near-infrared imaging coverage policy: there are no covered indications. None.
Aetna classifies every application of near-infrared vascular imaging and near-infrared fluorescence imaging as experimental, investigational, or unproven. The policy does not establish medical necessity criteria for any indication, because Aetna's position is that effectiveness has not been established for any of them. That's not an overstatement — that's the exact language in CPB 0846.
Whether you're asking about Aetna near-infrared fluorescence imaging billing for sentinel lymph node mapping, bile duct visualization, or colorectal neoplasia detection, the answer is the same. Aetna will not reimburse these services. Prior authorization won't help you here, because prior authorization doesn't exist for services Aetna considers experimental. There's no pathway to coverage under this policy.
The real issue for billing teams is exposure from surgeons who use these technologies routinely — particularly in robotic and laparoscopic cases — and assume coverage follows the procedure. It doesn't. The underlying surgical procedure may be covered, but the near-infrared imaging component billed separately is not.
Aetna Near-Infrared Imaging Exclusions and Non-Covered Indications
The scope of what Aetna excludes here is unusually broad. This isn't a policy that carves out one or two fringe uses. It covers more than 27 specific named indications — and explicitly states the list is not all-inclusive.
The major exclusion categories are worth knowing cold, because they map directly to the procedures your surgical teams perform most often.
Intraoperative fluorescence imaging with indocyanine green (ICG) is excluded across multiple surgical contexts. This includes bile duct identification during cholecystectomy (assessment of the cystic duct, common bile duct, and common hepatic duct), ureter delineation during laparoscopy, and intraoperative visualization of the urethra. Surgeons increasingly use ICG-assisted imaging as a safety tool. Aetna's position is that effectiveness remains unproven regardless of clinical adoption.
Sentinel lymph node mapping via NIRF imaging with ICG is excluded for cutaneous melanoma, oral squamous cell carcinoma, gastric cancer, and endometrial cancer. HCPCS C9756 — intraoperative near-infrared fluorescence lymphatic mapping — is specifically listed as a non-covered code under CPB 0846.
Oncologic surgery guidance is excluded broadly. This includes intraoperative detection of hepatocellular cancer, pancreatic cancer, lung cancer, lung metastases, mesothelioma, and localization of brain metastases. Detection of ovarian cancer metastases is also excluded.
Cision InVision short-wave infrared imaging for pathological imaging and CPT 0961T — the corresponding billing code — are explicitly excluded.
Vascular and cardiovascular applications are excluded, including evaluation of coronary atherosclerosis, identification of vulnerable atherosclerotic plaques, diagnosis of peripheral artery disease, and the hybrid NIRF-intravascular ultrasound (NIRF-IVUS) system for coronary and peripheral artery evaluation.
Gynecologic and urologic applications are excluded. NIR-ICG imaging for endometriosis and other benign gynecologic conditions is non-covered. So is near-infrared vascular imaging using devices like the AccuVein AV300 or VeinViewer for wound assessment or vascular access guidance.
Transcutaneous NIR spectroscopy (NIRS) for monitoring kidney and liver allograft perfusion after transplant is excluded. If your transplant program bills this separately, stop.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Short-wave infrared imaging (Cision InVision) for pathological imaging | Not Covered / Experimental | CPT 0961T | Explicitly listed as non-covered |
| Intraoperative NIRF imaging of extra-hepatic bile ducts with ICG | Not Covered / Experimental | — | Includes cystic duct, common bile duct, common hepatic duct |
| Intraparenchymal NIRS for delayed cerebral ischemia in subarachnoid hemorrhage | Not Covered / Experimental | I60.0–I60.9, I67.82 | — |
| NIRF imaging with ICG for sentinel lymph nodes in cutaneous melanoma | Not Covered / Experimental | HCPCS C9756 | — |
| NIRF imaging with ICG for sentinel lymph nodes in oral squamous cell carcinoma | Not Covered / Experimental | HCPCS C9756 | — |
| Assessment of liver function via NIRF | Not Covered / Experimental | — | — |
| Ureteral delineation during laparoscopy | Not Covered / Experimental | CPT 50947, 50948, 50949 | — |
| Detection and resection of colorectal neoplasia | Not Covered / Experimental | — | — |
| Detection of ovarian cancer metastases | Not Covered / Experimental | C00.0–D49.9 | — |
| Diagnosis of peripheral artery disease via NIRF | Not Covered / Experimental | — | — |
| Evaluation of coronary atherosclerosis | Not Covered / Experimental | I25.10–I25.9 | — |
| Identification of vulnerable atherosclerotic plaques | Not Covered / Experimental | I70.0–I70.9x | — |
| Sentinel lymph node mapping in gastric cancer | Not Covered / Experimental | HCPCS C9756 | — |
| Sentinel lymph node mapping in endometrial cancer | Not Covered / Experimental | HCPCS C9756 | — |
| Intraoperative detection of hepatocellular cancer after RFA | Not Covered / Experimental | CPT 47380, 47382 | Includes needle tract implantation and peritoneal seeding detection |
| Intraoperative detection of pancreatic cancer and metastases | Not Covered / Experimental | — | — |
| Intraoperative imaging of lung cancer/mesothelioma | Not Covered / Experimental | C00.0–D49.9 | — |
| Intraoperative urethral visualization for injury prevention | Not Covered / Experimental | — | — |
| Localization of brain metastases | Not Covered / Experimental | C00.0–D49.9 | — |
| Laparoscopic anatomy navigation during GI surgery | Not Covered / Experimental | — | — |
| Guidance in amputation surgery | Not Covered / Experimental | — | — |
| Guidance for intracranial meningioma surgery | Not Covered / Experimental | — | — |
| NIR-ICG for benign gynecologic conditions (e.g., endometriosis) | Not Covered / Experimental | — | — |
| Transcutaneous NIRS for kidney and liver allograft perfusion monitoring | Not Covered / Experimental | — | — |
| Hybrid NIRF-IVUS for coronary and peripheral artery evaluation | Not Covered / Experimental | I25.10–I25.9, I70.x | Related: CPB 0382 |
| Near-infrared vascular imaging (AccuVein AV300, VeinViewer) for wound or vascular access | Not Covered / Experimental | — | — |
| Lymphatic imaging in Klippel-Trenaunay syndrome | Not Covered / Experimental | — | — |
| Lymphatic imaging in lymphangiomatosis | Not Covered / Experimental | — | — |
| Mapping microvascular circulation in ischemic diseases | Not Covered / Experimental | — | — |
| Diagnosis of rheumatoid arthritis via NIRF | Not Covered / Experimental | — | — |
| MMP-2 imaging in arterio-venous fistulae | Not Covered / Experimental | — | — |
| Esophagectomy gastroepiploic vessel confirmation | Not Covered / Experimental | — | — |
| Soft tissue viability for debridement in trauma surgery | Not Covered / Experimental | — | — |
| Selective arterial clamping during partial nephrectomy | Not Covered / Experimental | CPT 50545, 50546, 50548 | — |
| Anti-tumor vasculature therapy monitoring | Not Covered / Experimental | C00.0–D49.9 | — |
Aetna Near-Infrared Imaging Billing Guidelines and Action Items 2025
The effective date is December 6, 2025. Here's what your team should do before and after that date.
| # | Action Item |
|---|---|
| 1 | Flag CPT 0961T and HCPCS C9756 in your charge capture system as non-covered under Aetna. These are the primary codes directly called out in CPB 0846. Any claim pairing these codes with Aetna as the primary payer will deny. Set a hard stop or alert in your charge master now. |
| 2 | Audit any recent claims for HCPCS C9756 billed to Aetna. Look back 12 months. If your surgical team bills intraoperative NIRF lymphatic mapping separately on Aetna claims, you have existing claim denial exposure. Pull those remits and assess for recoupment risk. |
| 3 | Educate your surgical teams on the ICG documentation problem. Surgeons who use ICG fluorescence intraoperatively may document it in operative reports without flagging it as a separate billable service. Your coders need to know not to break it out as a separate charge on Aetna claims — even if the technology was used. |
| 4 | Review your laparoscopic surgery billing for secondary code exposure. CPT 50545, 50546, 50548 (laparoscopic nephrectomy procedures), CPT 50947, 50948, and 50949 (ureteroneocystostomy procedures), and CPT 47380 and 47382 (liver tumor ablation) are listed as "other CPT codes related to the CPB." If a provider performed one of these procedures and separately billed near-infrared imaging guidance, that imaging charge is non-covered. The underlying surgical code may still be payable — but the imaging component will not be. |
| 5 | Do not attempt prior authorization for these services under Aetna. Prior auth is not a pathway to coverage when Aetna classifies a service as experimental. Spending time pursuing authorization for CPT 0961T or HCPCS C9756 wastes your team's time and creates false expectations with your clinical staff. |
| 6 | Cross-check with CPB 0111 and CPB 0796. Aetna's CPB 0111 covers Indocyanine Green Angiography, and CPB 0796 covers near-infrared intravascular ultrasound coronary imaging (like the InfraReDx LipiScan system). If your billing team is coding ICG-related procedures, confirm they're referencing the right policy. ICG angiography under CPB 0111 operates under different rules than the NIRF imaging excluded under CPB 0846. |
| 7 | If your payer mix includes Aetna commercial and Aetna Medicare Advantage, treat both the same under this policy. CPB 0846 does not carve out Medicare Advantage plan exceptions. If you're unsure how your specific Aetna contracts interact with this CPB, loop in your compliance officer before the December 6, 2025 effective date. |
| 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 Imaging Under CPB 0846
Not Covered / Experimental Codes
| Code | Type | Description | Status |
|---|---|---|---|
| 0961T | CPT | Shortwave infrared radiation imaging, surgical pathology specimen, to assist gross examination | Not Covered — Experimental |
| C9756 | HCPCS | Intraoperative near-infrared fluorescence lymphatic mapping of lymph node(s) (sentinel or tumor draining) | Not Covered — Experimental |
Other CPT Codes Related to CPB 0846
These codes represent underlying surgical procedures. The procedure itself may be covered — the near-infrared imaging component billed separately is not.
| Code | Type | Description |
|---|---|---|
| 47380 | CPT | Ablation, open, of one or more liver tumor(s); radiofrequency |
| 47382 | CPT | Ablation, one or more liver tumor(s), percutaneous, radiofrequency |
| 50545 | CPT | Laparoscopy, surgical; radical nephrectomy (includes removal of Gerota's fascia and surrounding fatty tissue) |
| 50546 | CPT | Laparoscopy, surgical; nephrectomy, including partial ureterectomy |
| 50548 | CPT | Laparoscopy, surgical; nephrectomy with total ureterectomy |
| 50947 | CPT | Laparoscopy, surgical; ureteroneocystostomy with cystoscopy and ureteral stent placement |
| 50948 | CPT | Laparoscopy, surgical; ureteroneocystostomy without cystoscopy and ureteral stent placement |
| 50949 | CPT | Unlisted laparoscopy procedure, ureter |
Key ICD-10-CM Diagnosis Codes
| Code Range | Description |
|---|---|
| C00.0–D49.9 | Neoplasms — detection of tumor angiogenesis, monitoring of anti-tumor vasculature therapy response, intraoperative oncologic imaging |
| I25.10–I25.9 | Chronic ischemic heart disease — coronary atherosclerosis evaluation |
| I60.0–I60.9 | Nontraumatic subarachnoid hemorrhage — intraparenchymal NIRS for delayed cerebral ischemia |
| I67.82 | Cerebral ischemia |
| I70.0–I70.9x | Atherosclerosis — identification of vulnerable atherosclerotic plaques; peripheral artery disease |
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