Aetna · PayerPolicy · AETNA-CPB-0067
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 |
|---|---|---|
| 94667 | CPT | Covered |
| 94668 | CPT | Covered |
| 94669 | CPT | Covered |
| 97124 | CPT | Covered |
| A7020 | HCPCS | Covered |
| A7025 | HCPCS | Covered |
| A7026 | HCPCS | Covered |
| E0480 | HCPCS | Covered |
| E0481 | HCPCS | Covered |
| E0482 | HCPCS | Covered |
| E0483 | HCPCS | Covered |
| E0484 | HCPCS | Covered |
| G0237 | HCPCS | Covered |
| G0238 | HCPCS | Covered |
| S8185 | HCPCS | Covered |
| E71.510 | ICD10CM | Covered |
| E71.520 | ICD10CM | Covered |
| E71.529 | ICD10CM | Covered |
| E75.29 | ICD10CM | Covered |
| E84.0 | ICD10CM | Covered |
| E84.9 | ICD10CM | Covered |
| E88.81 | ICD10CM | Covered |
| E88.89 | ICD10CM | Covered |
| F00012 | ICD10CM | Covered |
| F84.2 | ICD10CM | Covered |
| G12.20 | ICD10CM | Covered |
| G12.29 | ICD10CM | Covered |
| G25.82 | ICD10CM | Covered |
| G61.81 | ICD10CM | Covered |
| G70.00 | ICD10CM | Covered |
| G73.7 | ICD10CM | Covered |
| G80.0 | ICD10CM | Covered |
| G80.9 | ICD10CM | Covered |
| G82.20 | ICD10CM | Covered |
| G82.54 | ICD10CM | Covered |
| G93.1 | ICD10CM | Covered |
| J18.9 | ICD10CM | Covered |
| J40 | ICD10CM | Covered |
| J41.0 | ICD10CM | Covered |
| J42 | ICD10CM | Covered |
| J44.0 | ICD10CM | Covered |
| J44.9 | ICD10CM | Covered |
| J45.20 | ICD10CM | Covered |
| J45.998 | ICD10CM | Covered |
| J47.0 | ICD10CM | Covered |
| J47.9 | ICD10CM | Covered |
| J84.01 | ICD10CM | Covered |
| J84.10 | ICD10CM | Covered |
| J84.9 | ICD10CM | Covered |
| J96.00 | ICD10CM | Covered |
| J96.02 | ICD10CM | Covered |
| J98.11 | ICD10CM | Covered |
| J98.6 | ICD10CM | Covered |
| Q33.4 | ICD10CM | Covered |
| Q93.4 | ICD10CM | Covered |
| R40.20 | ICD10CM | Covered |
| R40.236 | ICD10CM | Covered |
| R40.3 | ICD10CM | Covered |
| Z94.2 | ICD10CM | Covered |