Aetna · PayerPolicy · AETNA-CPB-0107
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 |
|---|---|---|
| 22505 | CPT | Covered |
| 95836 | CPT | Covered |
| 95857 | CPT | Covered |
| 95860 | CPT | Covered |
| 95887 | CPT | Covered |
| 95907 | CPT | Covered |
| 95913 | CPT | Covered |
| 95937 | CPT | Covered |
| 96000 | CPT | Covered |
| 96004 | CPT | Covered |
| 97010 | CPT | Covered |
| 97530 | CPT | Covered |
| 97799 | CPT | Covered |
| 98940 | CPT | Covered |
| 98941 | CPT | Covered |
| 98942 | CPT | Covered |
| 98943 | CPT | Covered |
| G0151 | HCPCS | Covered |
| S3900 | HCPCS | Covered |
| S9131 | HCPCS | Covered |
| F07.81 | ICD10CM | Covered |
| F32. | ICD10CM | Covered |
| F33. | ICD10CM | Covered |
| F84. | ICD10CM | Covered |
| F90. | ICD10CM | Covered |
| G24.3 | ICD10CM | Covered |
| G40. | ICD10CM | Covered |
| G43.001 | ICD10CM | Covered |
| G43.919 | ICD10CM | Covered |
| G44.001 | ICD10CM | Covered |
| G44.89 | ICD10CM | Covered |
| G54.0 | ICD10CM | Covered |
| G55 | ICD10CM | Covered |
| G56.00 | ICD10CM | Covered |
| G56.93 | ICD10CM | Covered |
| G57.00 | ICD10CM | Covered |
| G59 | ICD10CM | Covered |
| G71.0 | ICD10CM | Covered |
| G71.00 | ICD10CM | Covered |
| G72.9 | ICD10CM | Covered |
| G80.0 | ICD10CM | Covered |
| G80.9 | ICD10CM | Covered |
| H81. | ICD10CM | Covered |
| J45. | ICD10CM | Covered |
| K00 | ICD10CM | Covered |
| K95 | ICD10CM | Covered |
| M05.00 | ICD10CM | Covered |
| M08.99 | ICD10CM | Covered |
| M12.00 | ICD10CM | Covered |
| M13.89 | ICD10CM | Covered |
| M15.0 | ICD10CM | Covered |
| M19.93 | ICD10CM | Covered |
| M20.001 | ICD10CM | Covered |
| M25.9 | ICD10CM | Covered |
| M26.601 | ICD10CM | Covered |
| M26.69 | ICD10CM | Covered |
| M35.3 | ICD10CM | Covered |
| M40. | ICD10CM | Covered |
| M40.00 | ICD10CM | Covered |
| M40.51 | ICD10CM | Covered |
| M41. | ICD10CM | Covered |
| M42. | ICD10CM | Covered |
| M42.00 | ICD10CM | Covered |
| M54.9 | ICD10CM | Covered |
| M75.00 | ICD10CM | Covered |
| M79.9 | ICD10CM | Covered |
| M85.30 | ICD10CM | Covered |
| M85.39 | ICD10CM | Covered |
| M89.00 | ICD10CM | Covered |
| M89.09 | ICD10CM | Covered |
| M91.10 | ICD10CM | Covered |
| M94.9 | ICD10CM | Covered |
| M95. | ICD10CM | Covered |
| M99.00 | ICD10CM | Covered |
| M99.09 | ICD10CM | Covered |
| M99.10 | ICD10CM | Covered |
| M99.19 | ICD10CM | Covered |
| M99.83 | ICD10CM | Covered |
| M99.84 | ICD10CM | Covered |
| N94.4 | ICD10CM | Covered |
| N94.6 | ICD10CM | Covered |
| N95.1 | ICD10CM | Covered |
| N97. | ICD10CM | Covered |
| Q65.00 | ICD10CM | Covered |
| Q68.8 | ICD10CM | Covered |
| Q72.70 | ICD10CM | Covered |
| Q72.73 | ICD10CM | Covered |
| Q74.0 | ICD10CM | Covered |
| Q74.1 | ICD10CM | Covered |
| Q74.2 | ICD10CM | Covered |
| Q74.9 | ICD10CM | Covered |
| Q76.0 | ICD10CM | Covered |
| Q76.49 | ICD10CM | Covered |
| Q77. | ICD10CM | Covered |
| Q78.9 | ICD10CM | Covered |
| Q87.89 | ICD10CM | Covered |
| R10.83 | ICD10CM | Covered |
| R42 | ICD10CM | Covered |
| R56. | ICD10CM | Covered |
| S03. | ICD10CM | Covered |
| S13. | ICD10CM | Covered |
| S23. | ICD10CM | Covered |
| S33. | ICD10CM | Covered |
| T12 | ICD10CM | Covered |
| Z91.81 | ICD10CM | Covered |