Aetna considers intra-coronary hyperoxemic therapy, also known as aqueous oxygen therapy or super-oxygenation therapy, experimental, investigational, or unproven for carbon monoxide poisoning, cardiogenic shock, radio-contrast nephropathy, reperfusion microvascular ischemia in persons with acute myocardial infarction, and stroke, because the evidence is insufficient and effectiveness has not been established. The policy states there are no specific CPT or HCPCS codes for hyperoxemic therapy. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline on the management of acute coronary syndromes does not provide a recommendation for intra-coronary hyperoxemic or supersaturated oxygen therapy.
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01Billing team: Do not bill intra-coronary hyperoxemic therapy for carbon monoxide poisoning, cardiogenic shock, radio-contrast nephropathy, reperfusion microvascular ischemia in persons with acute myocardial infarction, or stroke, because the policy considers it experimental, investigational, or unproven for these indications.
02Billing team: Check the diagnosis codes on the claim against the policy's list of not-covered ICD-10 codes, such as R57.0 for cardiogenic shock, before submitting claims for this therapy.
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