Aetna · PayerPolicy · AETNA-CPB-0009
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 |
|---|---|---|
| 29000 | CPT | Covered |
| 29580 | CPT | Covered |
| 29584 | CPT | Covered |
| A4467 | HCPCS | Covered |
| A4580 | HCPCS | Covered |
| A4590 | HCPCS | Covered |
| E1800 | HCPCS | Covered |
| E1802 | HCPCS | Covered |
| E1805 | HCPCS | Covered |
| E1810 | HCPCS | Covered |
| E1825 | HCPCS | Covered |
| E1840 | HCPCS | Covered |
| K0672 | HCPCS | Covered |
| K0901 | HCPCS | Covered |
| K0902 | HCPCS | Covered |
| L0112 | HCPCS | Covered |
| L0113 | HCPCS | Covered |
| L0120 | HCPCS | Covered |
| L0130 | HCPCS | Covered |
| L0200 | HCPCS | Covered |
| L0210 | HCPCS | Covered |
| L0220 | HCPCS | Covered |
| L1000 | HCPCS | Covered |
| L1499 | HCPCS | Covered |
| L1600 | HCPCS | Covered |
| L1690 | HCPCS | Covered |
| L1832 | HCPCS | Covered |
| L1833 | HCPCS | Covered |
| L1845 | HCPCS | Covered |
| L1847 | HCPCS | Covered |
| L1848 | HCPCS | Covered |
| L1851 | HCPCS | Covered |
| L1852 | HCPCS | Covered |
| L1900 | HCPCS | Covered |
| L1990 | HCPCS | Covered |
| L2000 | HCPCS | Covered |
| L2038 | HCPCS | Covered |
| L2385 | HCPCS | Covered |
| L2395 | HCPCS | Covered |
| L3650 | HCPCS | Covered |
| L4360 | HCPCS | Covered |
| L4361 | HCPCS | Covered |
| L4386 | HCPCS | Covered |
| L4387 | HCPCS | Covered |
| L4398 | HCPCS | Covered |
| Q4001 | HCPCS | Covered |
| Q4049 | HCPCS | Covered |
| Q4051 | HCPCS | Covered |
| S8450 | HCPCS | Covered |
| S8452 | HCPCS | Covered |
| A18.01 | ICD10CM | Covered |
| E08.40 | ICD10CM | Covered |
| E08.42 | ICD10CM | Covered |
| E09.40 | ICD10CM | Covered |
| E09.42 | ICD10CM | Covered |
| E10.40 | ICD10CM | Covered |
| E10.42 | ICD10CM | Covered |
| E11.40 | ICD10CM | Covered |
| E11.42 | ICD10CM | Covered |
| E13.40 | ICD10CM | Covered |
| E13.42 | ICD10CM | Covered |
| E66.01 | ICD10CM | Covered |
| E66.9 | ICD10CM | Covered |
| F44.4 | ICD10CM | Covered |
| F45.8 | ICD10CM | Covered |
| G13.0 | ICD10CM | Covered |
| G13.1 | ICD10CM | Covered |
| G24.3 | ICD10CM | Covered |
| G54.0 | ICD10CM | Covered |
| G56.00 | ICD10CM | Covered |
| G56.03 | ICD10CM | Covered |
| G73.7 | ICD10CM | Covered |
| L0210 | ICD10CM | Covered |
| M00.00 | ICD10CM | Covered |
| M06.88 | ICD10CM | Covered |
| M24.151 | ICD10CM | Covered |
| M24.159 | ICD10CM | Covered |
| M24.561 | ICD10CM | Covered |
| M24.569 | ICD10CM | Covered |
| M24.851 | ICD10CM | Covered |
| M24.859 | ICD10CM | Covered |
| M40.00 | ICD10CM | Covered |
| M41.9 | ICD10CM | Covered |
| M43. | ICD10CM | Covered |
| M43.6 | ICD10CM | Covered |
| M43.9 | ICD10CM | Covered |
| M96.2 | ICD10CM | Covered |
| M96.5 | ICD10CM | Covered |
| M99.9 | ICD10CM | Covered |
| P15.8 | ICD10CM | Covered |
| Q65.00 | ICD10CM | Covered |
| Q65.6 | ICD10CM | Covered |
| Q65.9 | ICD10CM | Covered |
| Q66.0 | ICD10CM | Covered |
| Q68.0 | ICD10CM | Covered |
| Q68.5 | ICD10CM | Covered |
| Q68.8 | ICD10CM | Covered |
| Q79.9 | ICD10CM | Covered |
| Q87.0 | ICD10CM | Covered |
| R29.891 | ICD10CM | Covered |
| R68.89 | ICD10CM | Covered |
| S03. | ICD10CM | Covered |
| S10. | ICD10CM | Covered |
| S11. | ICD10CM | Covered |
| S13. | ICD10CM | Covered |
| S19. | ICD10CM | Covered |
| S23. | ICD10CM | Covered |
| S29.011 | ICD10CM | Covered |
| S29.019 | ICD10CM | Covered |
| S33. | ICD10CM | Covered |
| S39.011 | ICD10CM | Covered |
| S39.013 | ICD10CM | Covered |
| S43. | ICD10CM | Covered |
| S43.001 | ICD10CM | Covered |
| S43.396 | ICD10CM | Covered |
| S43.401 | ICD10CM | Covered |
| S46 | ICD10CM | Covered |
| S53 | ICD10CM | Covered |
| S56 | ICD10CM | Covered |
| S63 | ICD10CM | Covered |
| S66 | ICD10CM | Covered |
| S73 | ICD10CM | Covered |
| S76 | ICD10CM | Covered |
| S83 | ICD10CM | Covered |
| S86 | ICD10CM | Covered |
| S93 | ICD10CM | Covered |
| S93.401 | ICD10CM | Covered |
| S93.699 | ICD10CM | Covered |
| S96 | ICD10CM | Covered |
| S96.011 | ICD10CM | Covered |
| S96.019 | ICD10CM | Covered |
| S96.111 | ICD10CM | Covered |
| S96.119 | ICD10CM | Covered |
| S96.211 | ICD10CM | Covered |
| S96.219 | ICD10CM | Covered |
| S96.811 | ICD10CM | Covered |
| S96.819 | ICD10CM | Covered |
| S96.911 | ICD10CM | Covered |
| S96.919 | ICD10CM | Covered |
| Z46.89 | ICD10CM | Covered |
| Z48.89 | ICD10CM | Covered |
| Z96.60 | ICD10CM | Covered |
| Z96.698 | ICD10CM | Covered |
| Z97.10 | ICD10CM | Covered |
| Z97.16 | ICD10CM | Covered |
| Z98.1 | ICD10CM | Covered |