Indirect Measurement of Left Ventricular Filling Pressure (LVFP)
Customize your policy alerts
Sign up for Aetna Policy 0704 alerts
Get alerted when Policy 0704 changes without checking for updates manually.
Monitor payer policy activity
Defines Aetna's coverage stance for indirect, noninvasive measurement methods of LV filling pressure (e.g., VeriCor) and AI echocardiography tools (EchoGo) for evaluation/management of heart failure and related indications for Aetna members/providers.
No material clinical or coverage changes in this revision.
Coverage Criteria
Experimental and Investigational
Aetna considers the following interventions experimental and investigational because effectiveness has not been established:
VeriCor has limited supporting data (accuracy study and small randomized trial) and overall clinical utility remains unproven per ACC/AHA guidance.
AI-based post-processing shows potential for detection of HFpEF but lacks sufficient outcome data to establish clinical benefit.
Aetna considers the use of the AI echocardiography post‑processing platform EchoGo Heart Failure (HCPCS C9786) to be experimental and investigational because effectiveness has not been established for detection of HFpEF or other indications. EchoGo Heart Failure is identified in the policy as a not‑covered post‑processing service for the indications listed.
Computerized arterial waveform calibration methods for estimation of left ventricular filling pressure (for example, analysis of arterial waveform response to the Valsalva maneuver) are also considered experimental and investigational due to insufficient evidence of clinical value in the diagnosis and management of congestive heart failure or other indications.
Indirect measurement of left ventricular filling pressure (LVFP) by computerized calibration of the arterial waveform response to the Valsalva maneuver (e.g., the VeriCor System) is classified as experimental and investigational because clinical effectiveness has not been established.
EchoGo Heart Failure is likewise classified as experimental and investigational for detection of heart failure with preserved ejection fraction and for all other indications because effectiveness has not been established; claims for the associated HCPCS code C9786 are identified in the policy as not covered for the listed indications.
Coding
| C9786 | Echocardiography image post processing for computer aided detection of heart failure with preserved ejection fraction, including interpretation and report [EchoGo Heart Failure] |
| I50.1-I50.9 | Heart failure (ICD-10 codes listed as examples of not-covered indications in this CPB) |
Provider Actions and Requirements
Billing and Coverage — Not Covered Codes
Claims for HCPCS C9786 (EchoGo Heart Failure — echocardiography image post processing for computer aided detection of heart failure with preserved ejection fraction, including interpretation and report) and related ICD-10 heart failure diagnosis codes (I50.1–I50.9) are identified as not covered for the indications listed in this Clinical Policy Bulletin. Providers should expect claim denials when these codes are submitted for the excluded indications.
- HCPCS: C9786 — Echocardiography image post processing for computer aided detection of heart failure with preserved ejection fraction (EchoGo Heart Failure)
- ICD-10: I50.1–I50.9 — Heart failure codes (not covered for indications listed in this CPB)
Clinical Role — Uncertain Utility of Noninvasive Hemodynamic Measurements
Noninvasive hemodynamic measurements (including systems that estimate left ventricular filling pressure such as EchoGo or computerized calibration of arterial waveform response to the Valsalva maneuver) currently have an uncertain role compared with routine clinical assessment. The policy notes that available evidence does not establish clinical utility for these indirect measurements for the diagnosis or management of heart failure; published clinical outcome data and randomized studies demonstrating impact on management and outcomes are required before adoption.
- Noninvasive estimates of LVFP have not been shown to be more valuable than routine clinical tests, including physical exam
- Evidence is inadequate to support routine use for guiding therapy or predicting deterioration
Prior Authorization / Coverage Review
Prior authorization or coverage review may be required for novel post-processing services such as EchoGo (HCPCS C9786). Services billed with HCPCS C9786 have been identified as not covered for the indications listed in this bulletin; when review is available, prior authorization decisions will reference this Clinical Policy Bulletin.
- Prior authorization/coverage review may be used to confirm indications and medical necessity
- Aetna’s Clinical Policy Bulletin will be used to assist in administering plan benefits but does not guarantee coverage
Provider Responsibility and Documentation
Providers are responsible for medical advice, treatment decisions, and documentation in the member’s medical record. The Clinical Policy Bulletin is provided to assist in administering plan benefits and is not a substitute for clinical judgment. Inclusion in this bulletin does not guarantee coverage; providers should follow plan provisions and submit complete documentation when requesting prior authorization or appealing denials.
- Treating providers are solely responsible for medical advice and treatment
- Clinical Policy Bulletins assist in administering benefits and do not constitute guarantees of coverage
Evidence Requirements for Adoption
Aetna requires adequate clinical trial evidence and published outcome data (for example, randomized controlled trials and studies demonstrating correlation with catheter-measured LVEDP and impact on patient outcomes) before adopting noninvasive LVFP estimation technologies into covered practice. Until such evidence is available, these interventions are considered experimental and investigational.
- Requirement for randomized studies or robust clinical outcome data demonstrating benefit
- Correlation with invasive catheter LVEDP and demonstration of improved clinical outcomes required for adoption
Background
Left ventricular end‑diastolic pressure (LVEDP) is the pressure in the left ventricle at the end of diastole and is commonly elevated in congestive heart failure; it is a direct measure of left ventricular filling pressure that reflects cardiac preload and can indicate decompensation.
Direct measurement of LVEDP is obtained by left‑heart catheterization (invasive hemodynamic assessment) or estimated indirectly by pulmonary capillary wedge pressure; noninvasive approaches that attempt to estimate LVEDP (for example, arterial waveform analysis with Valsalva calibration) have been proposed but lack sufficient evidence to replace direct catheter measurement for clinical decision making.
Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.