Aetna · PayerPolicy · AETNA-CPB-0016
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 |
|---|---|---|
| 15769 | CPT | Covered |
| 22510 | CPT | Covered |
| 22511 | CPT | Covered |
| 22512 | CPT | Covered |
| 22513 | CPT | Covered |
| 22514 | CPT | Covered |
| 22515 | CPT | Covered |
| 22548 | CPT | Covered |
| 22630 | CPT | Covered |
| 22632 | CPT | Covered |
| 22812 | CPT | Covered |
| 22853 | CPT | Covered |
| 22854 | CPT | Covered |
| 22859 | CPT | Covered |
| 22867 | CPT | Covered |
| 22868 | CPT | Covered |
| 22869 | CPT | Covered |
| 22870 | CPT | Covered |
| 27006 | CPT | Covered |
| 27035 | CPT | Covered |
| 27279 | CPT | Covered |
| 27280 | CPT | Covered |
| 62263 | CPT | Covered |
| 62264 | CPT | Covered |
| 62280 | CPT | Covered |
| 62282 | CPT | Covered |
| 62287 | CPT | Covered |
| 62302 | CPT | Covered |
| 62305 | CPT | Covered |
| 62380 | CPT | Covered |
| 63081 | CPT | Covered |
| 63082 | CPT | Covered |
| 64420 | CPT | Covered |
| 64421 | CPT | Covered |
| 64479 | CPT | Covered |
| 64484 | CPT | Covered |
| 64625 | CPT | Covered |
| 64628 | CPT | Covered |
| 64629 | CPT | Covered |
| 64633 | CPT | Covered |
| 64634 | CPT | Covered |
| 64635 | CPT | Covered |
| 64636 | CPT | Covered |
| 64712 | CPT | Covered |
| 77080 | CPT | Covered |
| 77085 | CPT | Covered |
| 77086 | CPT | Covered |
| C1062 | HCPCS | Covered |
| C1821 | HCPCS | Covered |
| C7504 | HCPCS | Covered |
| C7505 | HCPCS | Covered |
| C7507 | HCPCS | Covered |
| C7508 | HCPCS | Covered |
| C9757 | HCPCS | Covered |
| G0276 | HCPCS | Covered |
| J0702 | HCPCS | Covered |
| J1020 | HCPCS | Covered |
| J1030 | HCPCS | Covered |
| J1040 | HCPCS | Covered |
| J1094 | HCPCS | Covered |
| J1100 | HCPCS | Covered |
| J1700 | HCPCS | Covered |
| J1710 | HCPCS | Covered |
| J1720 | HCPCS | Covered |
| J1885 | HCPCS | Covered |
| J2001 | HCPCS | Covered |
| J2650 | HCPCS | Covered |
| J2920 | HCPCS | Covered |
| J2930 | HCPCS | Covered |
| J3300 | HCPCS | Covered |
| J3304 | HCPCS | Covered |
| J3420 | HCPCS | Covered |
| J3470 | HCPCS | Covered |
| J3473 | HCPCS | Covered |
| J3475 | HCPCS | Covered |
| C41.2 | ICD10CM | Covered |
| C41.4 | ICD10CM | Covered |
| C70.1 | ICD10CM | Covered |
| C72.0 | ICD10CM | Covered |
| C76.3 | ICD10CM | Covered |
| C79.31 | ICD10CM | Covered |
| C79.32 | ICD10CM | Covered |
| C79.49 | ICD10CM | Covered |
| C79.51 | ICD10CM | Covered |
| C79.52 | ICD10CM | Covered |
| C83.30 | ICD10CM | Covered |
| C95.92 | ICD10CM | Covered |
| D16.8 | ICD10CM | Covered |
| D18.09 | ICD10CM | Covered |
| D32.1 | ICD10CM | Covered |
| D33.4 | ICD10CM | Covered |
| D42.0 | ICD10CM | Covered |
| D42.9 | ICD10CM | Covered |
| D43.0 | ICD10CM | Covered |
| D43.2 | ICD10CM | Covered |
| D43.4 | ICD10CM | Covered |
| D48.0 | ICD10CM | Covered |
| E88.89 | ICD10CM | Covered |
| G03.0 | ICD10CM | Covered |
| G03.9 | ICD10CM | Covered |
| G06.1 | ICD10CM | Covered |
| G54.8 | ICD10CM | Covered |
| G57.00 | ICD10CM | Covered |
| G57.03 | ICD10CM | Covered |
| J1100 | ICD10CM | Covered |
| M01. | ICD10CM | Covered |
| M02.88 | ICD10CM | Covered |
| M24.08 | ICD10CM | Covered |
| M25.751 | ICD10CM | Covered |
| M25.759 | ICD10CM | Covered |
| M25.78 | ICD10CM | Covered |
| M40.50 | ICD10CM | Covered |
| M40.57 | ICD10CM | Covered |
| M41.00 | ICD10CM | Covered |
| M41.35 | ICD10CM | Covered |
| M41.80 | ICD10CM | Covered |
| M41.9 | ICD10CM | Covered |
| M43.00 | ICD10CM | Covered |
| M43.19 | ICD10CM | Covered |
| M43.9 | ICD10CM | Covered |
| M46.1 | ICD10CM | Covered |
| M46.20 | ICD10CM | Covered |
| M46.30 | ICD10CM | Covered |
| M48. | ICD10CM | Covered |
| M48.02 | ICD10CM | Covered |
| M48.061 | ICD10CM | Covered |
| M48.07 | ICD10CM | Covered |
| M48.30 | ICD10CM | Covered |
| M48.38 | ICD10CM | Covered |
| M50.00 | ICD10CM | Covered |
| M50.03 | ICD10CM | Covered |
| M50.20 | ICD10CM | Covered |
| M50.23 | ICD10CM | Covered |
| M51.06 | ICD10CM | Covered |
| M51.07 | ICD10CM | Covered |
| M51.26 | ICD10CM | Covered |
| M51.27 | ICD10CM | Covered |
| M51.34 | ICD10CM | Covered |
| M51.35 | ICD10CM | Covered |
| M51.36 | ICD10CM | Covered |
| M51.37 | ICD10CM | Covered |
| M51.9 | ICD10CM | Covered |
| M53.0 | ICD10CM | Covered |
| M53.1 | ICD10CM | Covered |
| M53.3 | ICD10CM | Covered |
| M53.81 | ICD10CM | Covered |
| M53.83 | ICD10CM | Covered |
| M54.00 | ICD10CM | Covered |
| M54.10 | ICD10CM | Covered |
| M54.11 | ICD10CM | Covered |
| M54.13 | ICD10CM | Covered |
| M54.14 | ICD10CM | Covered |
| M54.17 | ICD10CM | Covered |
| M54.18 | ICD10CM | Covered |
| M54.2 | ICD10CM | Covered |
| M54.30 | ICD10CM | Covered |
| M54.32 | ICD10CM | Covered |
| M54.50 | ICD10CM | Covered |
| M54.59 | ICD10CM | Covered |
| M54.6 | ICD10CM | Covered |
| M54.9 | ICD10CM | Covered |
| M70.60 | ICD10CM | Covered |
| M70.72 | ICD10CM | Covered |
| M72.9 | ICD10CM | Covered |
| M76.00 | ICD10CM | Covered |
| M76.22 | ICD10CM | Covered |
| M79.2 | ICD10CM | Covered |
| M80. | ICD10CM | Covered |
| M80.08 | ICD10CM | Covered |
| M81.0 | ICD10CM | Covered |
| M81.8 | ICD10CM | Covered |
| M84. | ICD10CM | Covered |
| M86.18 | ICD10CM | Covered |
| M86.28 | ICD10CM | Covered |
| M86.68 | ICD10CM | Covered |
| M89.78 | ICD10CM | Covered |
| M96.0 | ICD10CM | Covered |
| M96.5 | ICD10CM | Covered |
| Q76.2 | ICD10CM | Covered |
| S12. | ICD10CM | Covered |
| S12.000 | ICD10CM | Covered |
| S12.000A | ICD10CM | Covered |
| S12.691 | ICD10CM | Covered |
| S12.691S | ICD10CM | Covered |
| S22.000 | ICD10CM | Covered |
| S22.089 | ICD10CM | Covered |
| S31.000 | ICD10CM | Covered |
| S32. | ICD10CM | Covered |
| S32.000 | ICD10CM | Covered |
| S32.059 | ICD10CM | Covered |
| S32.301A | ICD10CM | Covered |
| S33.100 | ICD10CM | Covered |
| S33.141 | ICD10CM | Covered |
| S34.101 | ICD10CM | Covered |
| S34.129 | ICD10CM | Covered |
| Z98.1 | ICD10CM | Covered |