Aetna · PayerPolicy · AETNA-CPB-0135
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 |
|---|---|---|
| 97810 | CPT | Covered |
| 97811 | CPT | Covered |
| 97813 | CPT | Covered |
| 97814 | CPT | Covered |
| S8930 | HCPCS | Covered |
| B02.21 | ICD10CM | Covered |
| B02.29 | ICD10CM | Covered |
| B18.0 | ICD10CM | Covered |
| B18.1 | ICD10CM | Covered |
| B20 | ICD10CM | Covered |
| B26.0 | ICD10CM | Covered |
| B26.9 | ICD10CM | Covered |
| D25.0 | ICD10CM | Covered |
| D25.9 | ICD10CM | Covered |
| D72.819 | ICD10CM | Covered |
| E28.2 | ICD10CM | Covered |
| E28.310 | ICD10CM | Covered |
| E66.01 | ICD10CM | Covered |
| E66.1 | ICD10CM | Covered |
| E66.3 | ICD10CM | Covered |
| E66.9 | ICD10CM | Covered |
| E89.41 | ICD10CM | Covered |
| F01.50 | ICD10CM | Covered |
| F99 | ICD10CM | Covered |
| G12.21 | ICD10CM | Covered |
| G20 | ICD10CM | Covered |
| G21.9 | ICD10CM | Covered |
| G25.81 | ICD10CM | Covered |
| G30.0 | ICD10CM | Covered |
| G30.9 | ICD10CM | Covered |
| G31.84 | ICD10CM | Covered |
| G35 | ICD10CM | Covered |
| G40.0 | ICD10CM | Covered |
| G40.91 | ICD10CM | Covered |
| G43.001 | ICD10CM | Covered |
| G43.919 | ICD10CM | Covered |
| G44.1 | ICD10CM | Covered |
| G47.00 | ICD10CM | Covered |
| G47.09 | ICD10CM | Covered |
| G47.30 | ICD10CM | Covered |
| G47.33 | ICD10CM | Covered |
| G47.8 | ICD10CM | Covered |
| G50.0 | ICD10CM | Covered |
| G64 | ICD10CM | Covered |
| G80.0 | ICD10CM | Covered |
| G80.9 | ICD10CM | Covered |
| G90.50 | ICD10CM | Covered |
| G90.59 | ICD10CM | Covered |
| H04.121 | ICD10CM | Covered |
| H04.129 | ICD10CM | Covered |
| H40.001 | ICD10CM | Covered |
| H40.9 | ICD10CM | Covered |
| H52.10 | ICD10CM | Covered |
| H52.13 | ICD10CM | Covered |
| H53.001 | ICD10CM | Covered |
| H53.039 | ICD10CM | Covered |
| H90.3 | ICD10CM | Covered |
| H90.5 | ICD10CM | Covered |
| H93. | ICD10CM | Covered |
| H93.11 | ICD10CM | Covered |
| H93.19 | ICD10CM | Covered |
| J00 | ICD10CM | Covered |
| J99 | ICD10CM | Covered |
| K08.9 | ICD10CM | Covered |
| K11.7 | ICD10CM | Covered |
| K12.30 | ICD10CM | Covered |
| K12.39 | ICD10CM | Covered |
| K14.6 | ICD10CM | Covered |
| K25.0 | ICD10CM | Covered |
| K25.9 | ICD10CM | Covered |
| K27.0 | ICD10CM | Covered |
| K27.9 | ICD10CM | Covered |
| K30 | ICD10CM | Covered |
| K31.84 | ICD10CM | Covered |
| K50.0 | ICD10CM | Covered |
| K51.9 | ICD10CM | Covered |
| K58.0 | ICD10CM | Covered |
| K58.9 | ICD10CM | Covered |
| K59.00 | ICD10CM | Covered |
| K59.09 | ICD10CM | Covered |
| K75.81 | ICD10CM | Covered |
| K76.0 | ICD10CM | Covered |
| K85.00 | ICD10CM | Covered |
| K85.92 | ICD10CM | Covered |
| K91.89 | ICD10CM | Covered |
| L29.0 | ICD10CM | Covered |
| L29.9 | ICD10CM | Covered |
| L40.0 | ICD10CM | Covered |
| L40.9 | ICD10CM | Covered |
| L70.0 | ICD10CM | Covered |
| L70.9 | ICD10CM | Covered |
| M05.00 | ICD10CM | Covered |
| M06.9 | ICD10CM | Covered |
| M08.00 | ICD10CM | Covered |
| M08.99 | ICD10CM | Covered |
| M16.0 | ICD10CM | Covered |
| M16.12 | ICD10CM | Covered |
| M16.2 | ICD10CM | Covered |
| M16.7 | ICD10CM | Covered |
| M16.9 | ICD10CM | Covered |
| M17.0 | ICD10CM | Covered |
| M17.12 | ICD10CM | Covered |
| M17.2 | ICD10CM | Covered |
| M17.5 | ICD10CM | Covered |
| M17.9 | ICD10CM | Covered |
| M25.721 | ICD10CM | Covered |
| M25.729 | ICD10CM | Covered |
| M26.601 | ICD10CM | Covered |
| M26.69 | ICD10CM | Covered |
| M30.0 | ICD10CM | Covered |
| M31.9 | ICD10CM | Covered |
| M47 | ICD10CM | Covered |
| M50 | ICD10CM | Covered |
| M54.2 | ICD10CM | Covered |
| M54.50 | ICD10CM | Covered |
| M54.59 | ICD10CM | Covered |
| M60.80 | ICD10CM | Covered |
| M60.9 | ICD10CM | Covered |
| M62.40 | ICD10CM | Covered |
| M62.49 | ICD10CM | Covered |
| M72.2 | ICD10CM | Covered |
| M75 | ICD10CM | Covered |
| M77.10 | ICD10CM | Covered |
| M77.12 | ICD10CM | Covered |
| M79.10 | ICD10CM | Covered |
| M79.18 | ICD10CM | Covered |
| M79.2 | ICD10CM | Covered |
| M80. | ICD10CM | Covered |
| M81.8 | ICD10CM | Covered |
| M96.1 | ICD10CM | Covered |
| N23 | ICD10CM | Covered |
| N39.3 | ICD10CM | Covered |
| N39.8 | ICD10CM | Covered |
| N46.0 | ICD10CM | Covered |
| N46.9 | ICD10CM | Covered |
| N52.01 | ICD10CM | Covered |
| N52.9 | ICD10CM | Covered |
| N53.11 | ICD10CM | Covered |
| N53.9 | ICD10CM | Covered |
| N80 | ICD10CM | Covered |
| N94.4 | ICD10CM | Covered |
| N94.6 | ICD10CM | Covered |
| N95.1 | ICD10CM | Covered |
| N97.0 | ICD10CM | Covered |
| N97.9 | ICD10CM | Covered |
| P11.3 | ICD10CM | Covered |
| P19.0 | ICD10CM | Covered |
| P28.9 | ICD10CM | Covered |
| P91.60 | ICD10CM | Covered |
| P91.63 | ICD10CM | Covered |
| R06.00 | ICD10CM | Covered |
| R06.09 | ICD10CM | Covered |
| R07.82 | ICD10CM | Covered |
| R07.89 | ICD10CM | Covered |
| R10.83 | ICD10CM | Covered |
| R11.2 | ICD10CM | Covered |
| R19.7 | ICD10CM | Covered |
| R32 | ICD10CM | Covered |
| R37 | ICD10CM | Covered |
| R51.0 | ICD10CM | Covered |
| R51.9 | ICD10CM | Covered |
| R53.81 | ICD10CM | Covered |
| R53.83 | ICD10CM | Covered |
| R63.2 | ICD10CM | Covered |
| R63.5 | ICD10CM | Covered |
| S13. | ICD10CM | Covered |
| S16 | ICD10CM | Covered |
| T45. | ICD10CM | Covered |
| T78.40X | ICD10CM | Covered |
| Z68.30 | ICD10CM | Covered |
| Z68.45 | ICD10CM | Covered |
| Z98.89 | ICD10CM | Covered |