CurrentAetnaPolicy 0692

Acoustic Heart Sound Recording and Computer Analysis

Defines Aetna's clinical policy on use of acoustic heart sound recording and computer analysis and related technologies (auscultation jacket, ballistocardiography, optical vibrocardiography, phonocardiography, vectorcardiography), stating these interventions are considered experimental and investigational due to insufficient evidence of improved clinical outcomes.

Policy Summary

PayerAetna

PolicyAcoustic Heart Sound Recording and Computer Analysis

Policy CodePolicy 0692

Change TypeNo material change

Effective DateAug 13, 2004

Next Review DateJul 25, 2024

Key ActionClaims for these technologies are considered experimental and investigational due to lack of established clinical value; providers should not expect coverage and must document medical necessity if submitting.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes; policy remains that these technologies are considered experimental and investigational.

6Technologies deemed experimental/investigational

1HCPCS code explicitly listed (S3902)

Coverage Summary

Scope: Defines Aetna's clinical policy on use of acoustic heart sound recording and computer analysis and related technologies (auscultation jacket, ballistocardiography, optical vibrocardiography, phonocardiography, vectorcardiography). Coverage stance: Not covered — experimental and investigational (technologies considered to have insufficient evidence of improved clinical outcomes). Effective date: 2004-08-13. Last review: 2023-09-19. Next review: 2024-07-25. Policy number: 0692.

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Not Medically Necessary / Experimental Criteria

Experimental and Investigational / Not Medically Necessary

Aetna considers the following interventions experimental and investigational because the effectiveness of these approaches has not been established:

ALL of the following

Acoustic heart sound recording, computer analysis and interpretation because of a lack of clinical studies demonstrating that this technology improves clinical outcomes.
Auscultation jacket because its clinical value has not been established.
Ballistocardiography because its clinical value has not been established.
Optical vibrocardiography because its clinical value has not been established.
Phonocardiography because its clinical value has not been established.
Vectorcardiography because its clinical value has not been established.

Coding

Not covered / Experimental HCPCSHCPCSNot Covered

S3902

Ballistocardiogram

ICD-10 codes referenced (not all-inclusive) for indications listed in CPBICD-10

I00 - I99.9	Diseases of the circulatory system
R00.8 - R00.9	Other and unspecified abnormalities of heart beat
R01.0 - R01.2	Cardiac murmurs and other cardiac sounds
R09.89	Other specified symptoms and signs involving the circulatory and respiratory systems
R93.1	Abnormal findings on diagnostic imaging of heart and coronary circulation
R93.8	Abnormal findings on diagnostic imaging of other specified body structures
R94.30 - R94.39	Abnormal results of cardiovascular function studies
Z13.6	Encounter for screening for cardiovascular disorders

Provider Actions

Documentation Required

Use is considered experimental/investigational

Claims for acoustic heart sound recording and computer analysis and related technologies are considered experimental and investigational due to lack of established clinical value; providers should not expect coverage. If submitting claims, document medical necessity and include supporting clinical information, because these interventions have not been demonstrated to improve clinical outcomes and are listed as experimental/investigational in the policy.

Acoustic heart sound recording and computer analysis
Auscultation jacket
Ballistocardiography
Optical vibrocardiography
Phonocardiography
Vectorcardiography
HCPCS code S3902 (Ballistocardiogram)

Background and Evidence

Background: Computer-aided electronic auscultatory devices acquire, record, and analyze cardiac acoustic signals using signal-processing algorithms to identify heart sounds (S1, S2) and suspected murmurs to support physician evaluation. Examples include Zargis Acoustic Cardioscan and Audicor, both cleared by the FDA via 510(k) premarket notification rather than PMA-level evidence, and product labeling states they are not intended as a sole means of diagnosis and require physician over-read.

Evidence summary: Peer-reviewed literature is limited and inconclusive. Some studies (Watrous et al. 2008) showed increased sensitivity for murmur detection with computer-assisted auscultation in pre-recorded samples, while preclinical work (Luciani et al. 2019) found correlations between acoustic cardiography parameters and invasive measures in a small porcine model; overall clinical outcome impact and validity remain unestablished, and CMS has previously determined phonocardiography and vectorcardiography to be obsolete or of little clinical value.

Evidence

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Definitions