Intravascular Ultrasound (CPB 0382, reviewed 2026-05-26)
Aetna's clinical policy bulletin 0382 treats intravascular ultrasound (IVUS) as medically necessary when a symptomatic member's angiogram shows 50 to 70% stenosis before an intracoronary procedure, when suspected left main coronary disease is not shown by angiography, for guidance of vena caval filter placement, for guiding and immediately assessing coronary or graft interventions, for evaluating cardiac allograft vasculopathy after heart transplant, for diagnosing and following treatment of iliac vein compression (May-Thurner) syndrome, for type B aortic dissection treated with thoracic endovascular aneurysm repair when CT is poor quality or inconclusive, and for infra-inguinal arterial disease when CO2 angiography is used because standard contrast angiography is not possible. IVUS is considered experimental, investigational, or unproven for coronary artery disease screening, for virtual histology plaque evaluation, and for other indications including carotid artery stenosis evaluation, guidance of percutaneous mechanical thrombectomy for pulmonary embolism, chronic venous obstruction stenting, and stenting of non-coronary arteries.