Aetna · PayerPolicy · AETNA-CPB-0008
Summary of the payer’s published policy. Not a coverage determination — confirm with Aetna before submitting.
Free account. Policy pages stay open to everyone.
Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.
| Code | Code system | Status in this policy |
|---|---|---|
| 33615 | CPT | Covered |
| 33617 | CPT | Covered |
| 75561 | CPT | Covered |
| 76825 | CPT | Covered |
| 76826 | CPT | Covered |
| 76827 | CPT | Covered |
| 76828 | CPT | Covered |
| 93303 | CPT | Covered |
| 93304 | CPT | Covered |
| 93306 | CPT | Covered |
| 93308 | CPT | Covered |
| 93312 | CPT | Covered |
| 93314 | CPT | Covered |
| 93315 | CPT | Covered |
| 93317 | CPT | Covered |
| 93320 | CPT | Covered |
| 93321 | CPT | Covered |
| 93325 | CPT | Covered |
| 93350 | CPT | Covered |
| 93351 | CPT | Covered |
| 93650 | CPT | Covered |
| 93653 | CPT | Covered |
| 93654 | CPT | Covered |
| C1886 | HCPCS | Covered |
| A40.0 | ICD10CM | Covered |
| A40.9 | ICD10CM | Covered |
| A41.01 | ICD10CM | Covered |
| A41.02 | ICD10CM | Covered |
| A41.1 | ICD10CM | Covered |
| A41.2 | ICD10CM | Covered |
| A41.3 | ICD10CM | Covered |
| A41.4 | ICD10CM | Covered |
| A41.50 | ICD10CM | Covered |
| A41.51 | ICD10CM | Covered |
| A41.52 | ICD10CM | Covered |
| A41.53 | ICD10CM | Covered |
| A52.03 | ICD10CM | Covered |
| A54.83 | ICD10CM | Covered |
| B39.4 | ICD10CM | Covered |
| C38.0 | ICD10CM | Covered |
| D15.1 | ICD10CM | Covered |
| J81.0 | ICD10CM | Covered |
| M31.4 | ICD10CM | Covered |
| P02.3 | ICD10CM | Covered |
| P03.810 | ICD10CM | Covered |
| P03.819 | ICD10CM | Covered |
| P04.11 | ICD10CM | Covered |
| P04.19 | ICD10CM | Covered |
| P04.1A | ICD10CM | Covered |
| P04.3 | ICD10CM | Covered |
| P04.40 | ICD10CM | Covered |
| P04.49 | ICD10CM | Covered |
| P29.30 | ICD10CM | Covered |
| P29.38 | ICD10CM | Covered |
| P70.0 | ICD10CM | Covered |
| P70.1 | ICD10CM | Covered |
| P83.2 | ICD10CM | Covered |
| Q20.0 | ICD10CM | Covered |
| Q21.9 | ICD10CM | Covered |
| Q22.0 | ICD10CM | Covered |
| Q22.3 | ICD10CM | Covered |
| Q22.4 | ICD10CM | Covered |
| Q22.5 | ICD10CM | Covered |
| Q23.0 | ICD10CM | Covered |
| Q23.1 | ICD10CM | Covered |
| Q23.2 | ICD10CM | Covered |
| Q23.3 | ICD10CM | Covered |
| Q23.4 | ICD10CM | Covered |
| Q24.2 | ICD10CM | Covered |
| Q24.3 | ICD10CM | Covered |
| Q24.4 | ICD10CM | Covered |
| Q24.8 | ICD10CM | Covered |
| Q26.0 | ICD10CM | Covered |
| Q26.9 | ICD10CM | Covered |
| Q86.0 | ICD10CM | Covered |
| Q87.40 | ICD10CM | Covered |
| Q87.43 | ICD10CM | Covered |
| R01.1 | ICD10CM | Covered |
| R06.0 | ICD10CM | Covered |
| R06.02 | ICD10CM | Covered |
| T82. | ICD10CM | Covered |
| T82.211 | ICD10CM | Covered |
| T82.218 | ICD10CM | Covered |
| T82.817 | ICD10CM | Covered |
| T86.20 | ICD10CM | Covered |
| T86.298 | ICD10CM | Covered |
| Z51.11 | ICD10CM | Covered |
| Z87.74 | ICD10CM | Covered |
| Z92.21 | ICD10CM | Covered |
| Z95.1 | ICD10CM | Covered |
| Z95.2 | ICD10CM | Covered |
| Z95.3 | ICD10CM | Covered |