CommercialCoverageHigh impact
Near-Infrared Vascular Imaging and Near-Infrared Fluorescence Imaging (CPB 0846, reviewed 2025-12-04)
Aetna·General Surgery, Cardiology, Oncology +10 more·Radiology
Effective date
Dec 4, 2025
We identified it
Aug 14, 2026
Summary
Aetna's new policy (CPB 0846, effective 2025-12-04) classifies near-infrared vascular imaging and near-infrared fluorescence imaging as experimental, investigational, or unproven for a comprehensive list of clinical indications. Billing teams must immediately identify and deny claims for these imaging modalities when used for any of the specified non-covered indications. CPT code 0961T (Cision InVision short-wave infrared) and HCPCS code C9756 (NIRF lymphatic mapping) are explicitly non-covered, and transcutaneous NIR spectroscopy for organ allograft monitoring has limited coverage only when selection criteria are met.
Action Required
By December 4, 2025: Billing team must implement the following: (1) Update billing software to flag and deny all claims for CPT 0961T (short-wave infrared pathology imaging) and HCPCS C9756 (intraoperative NIRF lymphatic mapping) regardless of indication; (2) Create a comprehensive denial logic matrix for near-infrared vascular imaging and fluorescence imaging procedures when associated with any ICD-10 diagnosis codes listed in the policy (neoplasms C00.0-D49.9, atherosclerosis I25.10-I25.9, I70.0-I70.92, rheumatoid arthritis M05.00-M06.9, endometriosis N80.00-N80.D9, subarachnoid hemorrhage I60.00-I60.9, cerebral ischemia I67.82, and all open wound codes S01.00xA through S91.359S); (3) Establish exception process for transcutaneous NIR spectroscopy (NIRS) for kidney allograft (Z48.22, Z94.0) and liver allograft monitoring (Z48.23, Z94.4) only—require prior authorization and documentation of selection criteria; (4) Brief providers (especially surgeons, interventional radiologists, and oncologists) that near-infrared imaging techniques are non-covered experimental procedures for all listed indications; (5) Update claim submission instructions and encounter forms to ensure providers understand these services require patient financial responsibility discussion. Failure to implement denials will result in improper payments. Reference related policies CPB 0111 (Indocyanine Green Angiography), CPB 0382 (Intravascular Ultrasound), and CPB 0796 (NIR Spectroscopy for IVUS coronary imaging) for any crossover scenarios.