Intravascular Ultrasound (CPB 0382, reviewed 2026-05-26)

By 2026-05-26: Billing team must update claim submission and authorization workflows to enforce Aetna's IVUS coverage criteria. (1) Configure billing system to require documented medical necessity for covered indications: 50-70% coronary stenosis evaluation, left main stem assessment, vena caval filter guidance, intracoronary device placement/assessment, cardiac allograft vasculopathy, May-Thurner syndrome, type B aortic dissection with TEVAR (when CT inconclusive), and infra-inguinal disease with CO2 angiography. (2) Flag and deny claims for experimental/investigational uses including: coronary artery disease screening, vulnerable plaque diagnosis, aortic dissection diagnosis, pulmonary hypertension evaluation, popliteal artery entrapment, hemodialysis graft interventions, carotid stenosis evaluation, chronic venous obstruction/stenting, pulmonary artery angioplasty, subclavian disease treatment, mechanical thrombectomy for PE, lower extremity arterial disease not meeting criteria above, and virtual histology IVUS. (3) Update prior authorization templates to require specific clinical documentation supporting one of the eight covered indications listed above. (4) Train providers and coders on this distinction; failure to obtain proper authorization or submit with inadequate justification will result in claim denials for Aetna members.