Aetna · PayerPolicy · AETNA-CPB-0113
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 |
|---|---|---|
| 43107 | CPT | Covered |
| 43124 | CPT | Covered |
| 76942 | CPT | Covered |
| 86609 | CPT | Covered |
| 95873 | CPT | Covered |
| 95874 | CPT | Covered |
| G11.4 | ICD10CM | Covered |
| G24.01 | ICD10CM | Covered |
| G24.02 | ICD10CM | Covered |
| G24.1 | ICD10CM | Covered |
| G24.3 | ICD10CM | Covered |
| G24.4 | ICD10CM | Covered |
| G24.5 | ICD10CM | Covered |
| G24.8 | ICD10CM | Covered |
| G25.0 | ICD10CM | Covered |
| G25.2 | ICD10CM | Covered |
| G25.3 | ICD10CM | Covered |
| G25.89 | ICD10CM | Covered |
| G35 | ICD10CM | Covered |
| G36.0 | ICD10CM | Covered |
| G37.9 | ICD10CM | Covered |
| G43.001 | ICD10CM | Covered |
| G43.919 | ICD10CM | Covered |
| G51.0 | ICD10CM | Covered |
| G51.9 | ICD10CM | Covered |
| G80.0 | ICD10CM | Covered |
| G80.9 | ICD10CM | Covered |
| G81.10 | ICD10CM | Covered |
| G81.14 | ICD10CM | Covered |
| G82.20 | ICD10CM | Covered |
| G83.34 | ICD10CM | Covered |
| H49.00 | ICD10CM | Covered |
| H51.9 | ICD10CM | Covered |
| J38.5 | ICD10CM | Covered |
| K11.7 | ICD10CM | Covered |
| K11.8 | ICD10CM | Covered |
| K22.0 | ICD10CM | Covered |
| K22.5 | ICD10CM | Covered |
| K44.9 | ICD10CM | Covered |
| K60.0 | ICD10CM | Covered |
| K60.4 | ICD10CM | Covered |
| L74.510 | ICD10CM | Covered |
| L74.519 | ICD10CM | Covered |
| L74.52 | ICD10CM | Covered |
| M25.71 | ICD10CM | Covered |
| M25.719 | ICD10CM | Covered |
| M25.811 | ICD10CM | Covered |
| M25.819 | ICD10CM | Covered |
| M26.601 | ICD10CM | Covered |
| M26.69 | ICD10CM | Covered |
| M34.0 | ICD10CM | Covered |
| M34.9 | ICD10CM | Covered |
| M35.00 | ICD10CM | Covered |
| M35.09 | ICD10CM | Covered |
| M41.00 | ICD10CM | Covered |
| M41.35 | ICD10CM | Covered |
| M47.12 | ICD10CM | Covered |
| M50.00 | ICD10CM | Covered |
| M50.03 | ICD10CM | Covered |
| M53.3 | ICD10CM | Covered |
| M54.2 | ICD10CM | Covered |
| M54.30 | ICD10CM | Covered |
| M54.59 | ICD10CM | Covered |
| M54.6 | ICD10CM | Covered |
| M54.81 | ICD10CM | Covered |
| M60.9 | ICD10CM | Covered |
| M62.48 | ICD10CM | Covered |
| M62.830 | ICD10CM | Covered |
| M62.89 | ICD10CM | Covered |
| M62.9 | ICD10CM | Covered |
| M67.00 | ICD10CM | Covered |
| M67.02 | ICD10CM | Covered |
| M71.18 | ICD10CM | Covered |
| M72.2 | ICD10CM | Covered |
| M72.9 | ICD10CM | Covered |
| M75.00 | ICD10CM | Covered |
| M75.92 | ICD10CM | Covered |
| M77.10 | ICD10CM | Covered |
| M77.12 | ICD10CM | Covered |
| M79.0 | ICD10CM | Covered |
| M79.10 | ICD10CM | Covered |
| M79.2 | ICD10CM | Covered |
| M91.10 | ICD10CM | Covered |
| M91.12 | ICD10CM | Covered |
| N30.10 | ICD10CM | Covered |
| N30.11 | ICD10CM | Covered |
| N31.0 | ICD10CM | Covered |
| N31.9 | ICD10CM | Covered |
| N32.81 | ICD10CM | Covered |
| N36.44 | ICD10CM | Covered |
| N39.0 | ICD10CM | Covered |
| N40.0 | ICD10CM | Covered |
| N40.3 | ICD10CM | Covered |
| N50.819 | ICD10CM | Covered |
| N64.4 | ICD10CM | Covered |
| N80. | ICD10CM | Covered |
| N80.00 | ICD10CM | Covered |
| N80.9 | ICD10CM | Covered |
| N82.0 | ICD10CM | Covered |
| N94.10 | ICD10CM | Covered |
| N94.19 | ICD10CM | Covered |
| N94.2 | ICD10CM | Covered |
| N94.810 | ICD10CM | Covered |
| N94.819 | ICD10CM | Covered |
| P14.0 | ICD10CM | Covered |
| P14.1 | ICD10CM | Covered |
| P14.3 | ICD10CM | Covered |
| Q05.0 | ICD10CM | Covered |
| Q05.9 | ICD10CM | Covered |
| Q10.0 | ICD10CM | Covered |
| Q35.0 | ICD10CM | Covered |
| Q35.9 | ICD10CM | Covered |
| Q36.0 | ICD10CM | Covered |
| Q36.9 | ICD10CM | Covered |
| Q37.0 | ICD10CM | Covered |
| Q37.9 | ICD10CM | Covered |
| Q43.1 | ICD10CM | Covered |
| Q43.2 | ICD10CM | Covered |
| Q64.10 | ICD10CM | Covered |
| Q64.19 | ICD10CM | Covered |
| Q66.0 | ICD10CM | Covered |
| Q66.80 | ICD10CM | Covered |
| Q66.89 | ICD10CM | Covered |
| Q87.3 | ICD10CM | Covered |
| R10.0 | ICD10CM | Covered |
| R10.9 | ICD10CM | Covered |
| R13.0 | ICD10CM | Covered |
| R13.19 | ICD10CM | Covered |
| R15.0 | ICD10CM | Covered |
| R15.9 | ICD10CM | Covered |
| R25.2 | ICD10CM | Covered |
| R33.0 | ICD10CM | Covered |
| R33.9 | ICD10CM | Covered |
| R49.0 | ICD10CM | Covered |
| R49.8 | ICD10CM | Covered |
| R51 | ICD10CM | Covered |
| R61 | ICD10CM | Covered |
| R68.84 | ICD10CM | Covered |
| S04. | ICD10CM | Covered |
| S04.011S | ICD10CM | Covered |
| S06. | ICD10CM | Covered |
| S13. | ICD10CM | Covered |
| S14. | ICD10CM | Covered |
| S24. | ICD10CM | Covered |
| S34. | ICD10CM | Covered |
| S73.101 | ICD10CM | Covered |
| S73.199 | ICD10CM | Covered |
| T67. | ICD10CM | Covered |
| T79. | ICD10CM | Covered |
| T85. | ICD10CM | Covered |
| Z98.89 | ICD10CM | Covered |