This paper reports an overview of biosensor technologies employing surface acoustic wave (SAW) principles for detection of biomarkers. First, the field of biosensors will be introduced in a broader framework through a general survey of the most popular transduction mechanisms in current biosensor research. Secondly, SAW based piezoelectric transduction mechanism along with device design approaches will be discussed. In this discussion, modeling, fabrication, optimization and characterization of SAW biosensors designed in CMOS technology will be laid out. An assortment of design novelties - such as circular architecture, embedded heaters, acoustic absorbers and their corresponding performance improvements will be introduced. In conclusion, we will list major research areas to be explored in developing sensitive biosensors by reflecting on problems encountered in improving sensitivity, selectivity, and specificity of such sensors throughout our CMOS-SAW biosensor research.