Aetna · PayerPolicy · AETNA-CPB-0029
Summary of the payer’s published policy. Not a coverage determination — confirm with Aetna before submitting.
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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 |
|---|---|---|
| 93740 | CPT | Covered |
| A30.0 | ICD10CM | Covered |
| A30.9 | ICD10CM | Covered |
| B02.22 | ICD10CM | Covered |
| B02.29 | ICD10CM | Covered |
| C00.0 | ICD10CM | Covered |
| C96.9 | ICD10CM | Covered |
| D18.00 | ICD10CM | Covered |
| D18.09 | ICD10CM | Covered |
| E08.3211 | ICD10CM | Covered |
| E10.51 | ICD10CM | Covered |
| E10.59 | ICD10CM | Covered |
| E11.51 | ICD10CM | Covered |
| E11.59 | ICD10CM | Covered |
| E13. | ICD10CM | Covered |
| E65 | ICD10CM | Covered |
| G56.00 | ICD10CM | Covered |
| G56.03 | ICD10CM | Covered |
| G71.09 | ICD10CM | Covered |
| G90.50 | ICD10CM | Covered |
| G90.59 | ICD10CM | Covered |
| H04.121 | ICD10CM | Covered |
| H04.129 | ICD10CM | Covered |
| L73.2 | ICD10CM | Covered |
| L76.01 | ICD10CM | Covered |
| L76.82 | ICD10CM | Covered |
| L89.000 | ICD10CM | Covered |
| L89.96 | ICD10CM | Covered |
| M05.00 | ICD10CM | Covered |
| M15.0 | ICD10CM | Covered |
| M19.93 | ICD10CM | Covered |
| M26.601 | ICD10CM | Covered |
| M26.69 | ICD10CM | Covered |
| M40.00 | ICD10CM | Covered |
| M43.9 | ICD10CM | Covered |
| M45.0 | ICD10CM | Covered |
| M49.89 | ICD10CM | Covered |
| M50.00 | ICD10CM | Covered |
| M54.9 | ICD10CM | Covered |
| M79.601 | ICD10CM | Covered |
| M79.609 | ICD10CM | Covered |
| M80. | ICD10CM | Covered |
| M81.0 | ICD10CM | Covered |
| M81.8 | ICD10CM | Covered |
| M84.421S | ICD10CM | Covered |
| M84.429S | ICD10CM | Covered |
| M84.431S | ICD10CM | Covered |
| M84.439S | ICD10CM | Covered |
| S12. | ICD10CM | Covered |
| S12.000A | ICD10CM | Covered |
| S22.000A | ICD10CM | Covered |
| S22.089S | ICD10CM | Covered |
| S32. | ICD10CM | Covered |
| S32.000A | ICD10CM | Covered |
| S42.209S | ICD10CM | Covered |
| S42.496S | ICD10CM | Covered |
| S49.001S | ICD10CM | Covered |
| S49.199S | ICD10CM | Covered |
| S52. | ICD10CM | Covered |
| S52.001S | ICD10CM | Covered |
| S52.501A | ICD10CM | Covered |
| S52.509S | ICD10CM | Covered |
| S52.531A | ICD10CM | Covered |
| S52.539S | ICD10CM | Covered |
| S59.001S | ICD10CM | Covered |
| S59.299S | ICD10CM | Covered |
| S62. | ICD10CM | Covered |
| T20. | ICD10CM | Covered |
| T32.99 | ICD10CM | Covered |
| Y84.2 | ICD10CM | Covered |
| Z01.810 | ICD10CM | Covered |
| Z01.818 | ICD10CM | Covered |
| Z01.89 | ICD10CM | Covered |
| Z12.0 | ICD10CM | Covered |
| Z12.9 | ICD10CM | Covered |
| Z13.820 | ICD10CM | Covered |
| Z13.828 | ICD10CM | Covered |
| Z13.89 | ICD10CM | Covered |
| Z42.1 | ICD10CM | Covered |
| Z42.8 | ICD10CM | Covered |
| Z51.11 | ICD10CM | Covered |
| Z51.12 | ICD10CM | Covered |
| Z95.1 | ICD10CM | Covered |