Aetna covers AI-powered coronary plaque assessments, joining other major insurers
Aetna, one of the largest insurance providers in the United States, now covers the use of artificial intelligence (AI)-enabled coronary plaque evaluations. This news follows similar announcements from Humana, Cigna and UnitedHealthcare; a majority of insured Americans can now be treated with these technologies and have the procedure covered by their provider.
The use of advanced AI software that can evaluate coronary CT angiography (CCTA) results and quantify a patient’s coronary plaque burden continues to be cardiology’s biggest trend. The U.S. Food and Drug Administration (FDA) has already approved noninvasive plaque analysis tools from Heartflow, Cleerly, Elucid, Circle Cardiovascular Imaging, Caristo Diagnostics and Artrya, and other AI companies are working to gain approval for their own offerings. In addition, these technologies received new Category 1 CPT codes in 2024, and then the Centers for Medicare and Medicaid Services more than doubled the reimbursements hospitals receive for performing CCTA examinations.
A closer look at what Aetna agreed to cover
Going forward, Aetna will cover the use of any FDA-cleared plaque quantification offering to evaluate patients with acute or stable chest pain with no known coronary artery disease (CAD) and a current CCTA exam on record. In addition, that CCTA should indicate that the patient faces at least an intermediate risk of CAD.
Plaque Analysis image courtesy of Heartflow.
AI companies cheer Aetna’s decision to cover AI-enabled coronary plaque evaluations
“Aetna’s decision to cover Heartflow Plaque Analysis nationwide is a pivotal step in expanding access to our AI-driven plaque quantification and characterization technology,” John Farquhar, president and CEO of Heartflow, said in a prepared statement celebrating the news. “With four major commercial payers and Medicare now recognizing the innovation and value of our platform, more clinicians can gain earlier, clearer insights into coronary plaque. More patients will benefit from early detection and precise quantification of plaque with Heartflow Plaque Analysis, leading to more personalized treatment strategies and improved prognostic assessment, helping set a new benchmark for cardiovascular care.”
“We're seeing unprecedented payor acceptance of AI-powered cardiovascular imaging,” James K. Min, MD, founder and CEO of Cleerly, said in a separate statement. “Major insurers, covering over 86 million lives, now recognize that AI-QCT delivers better patient outcomes while reducing costs. This is a fundamental shift in how we approach cardiac care.”
Click here and here for recent video interviews about CCTA's potential to change cardiac care forever. The AI platforms from Heartflow, Cleerly and others will play a central role in this trend going forward.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.