Aetna · PayerPolicy · AETNA-CPB-0140
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 |
|---|---|---|
| 81186 | CPT | Covered |
| 81216 | CPT | Covered |
| 81217 | CPT | Covered |
| 81222 | CPT | Covered |
| 81271 | CPT | Covered |
| 81274 | CPT | Covered |
| 81291 | CPT | Covered |
| 81312 | CPT | Covered |
| 81328 | CPT | Covered |
| 81329 | CPT | Covered |
| 81337 | CPT | Covered |
| 81353 | CPT | Covered |
| 81377 | CPT | Covered |
| 81383 | CPT | Covered |
| 81404 | CPT | Covered |
| 81405 | CPT | Covered |
| 81406 | CPT | Covered |
| 81410 | CPT | Covered |
| 81411 | CPT | Covered |
| 81425 | CPT | Covered |
| 81426 | CPT | Covered |
| 81435 | CPT | Covered |
| 81436 | CPT | Covered |
| 88381 | CPT | Covered |
| S3861 | HCPCS | Covered |
| S3865 | HCPCS | Covered |
| C43 | ICD10CM | Covered |
| C43.0 | ICD10CM | Covered |
| C43.9 | ICD10CM | Covered |
| C50.011 | ICD10CM | Covered |
| C50.929 | ICD10CM | Covered |
| C61 | ICD10CM | Covered |
| D37.1 | ICD10CM | Covered |
| D37.5 | ICD10CM | Covered |
| D46.0 | ICD10CM | Covered |
| D46.9 | ICD10CM | Covered |
| D46.Z | ICD10CM | Covered |
| D59.3 | ICD10CM | Covered |
| D60.0 | ICD10CM | Covered |
| D60.9 | ICD10CM | Covered |
| D61.01 | ICD10CM | Covered |
| D61.9 | ICD10CM | Covered |
| D68.00 | ICD10CM | Covered |
| D68.01 | ICD10CM | Covered |
| D68.020 | ICD10CM | Covered |
| D68.021 | ICD10CM | Covered |
| D68.022 | ICD10CM | Covered |
| D68.023 | ICD10CM | Covered |
| D68.029 | ICD10CM | Covered |
| D68.03 | ICD10CM | Covered |
| D68.04 | ICD10CM | Covered |
| D68.09 | ICD10CM | Covered |
| D68.1 | ICD10CM | Covered |
| D72.0 | ICD10CM | Covered |
| E34.50 | ICD10CM | Covered |
| E34.52 | ICD10CM | Covered |
| E71.310 | ICD10CM | Covered |
| E73.0 | ICD10CM | Covered |
| E73.9 | ICD10CM | Covered |
| E83.30 | ICD10CM | Covered |
| E83.39 | ICD10CM | Covered |
| E88.1 | ICD10CM | Covered |
| E88.89 | ICD10CM | Covered |
| F11 | ICD10CM | Covered |
| F51.3 | ICD10CM | Covered |
| G11.8 | ICD10CM | Covered |
| G12.0 | ICD10CM | Covered |
| G12.21 | ICD10CM | Covered |
| G12.9 | ICD10CM | Covered |
| G20 | ICD10CM | Covered |
| G20210A | ICD10CM | Covered |
| G21.9 | ICD10CM | Covered |
| G25.0 | ICD10CM | Covered |
| G25.3 | ICD10CM | Covered |
| G32.81 | ICD10CM | Covered |
| G40.301 | ICD10CM | Covered |
| G40.319 | ICD10CM | Covered |
| G43.401 | ICD10CM | Covered |
| G43.419 | ICD10CM | Covered |
| G47.411 | ICD10CM | Covered |
| G47.429 | ICD10CM | Covered |
| G71.09 | ICD10CM | Covered |
| H18.50 | ICD10CM | Covered |
| H18.59 | ICD10CM | Covered |
| H35.051 | ICD10CM | Covered |
| H35.059 | ICD10CM | Covered |
| H35.30 | ICD10CM | Covered |
| H35.33 | ICD10CM | Covered |
| H53.63 | ICD10CM | Covered |
| H55.89 | ICD10CM | Covered |
| H90.0 | ICD10CM | Covered |
| H91.93 | ICD10CM | Covered |
| J84.10 | ICD10CM | Covered |
| J84.83 | ICD10CM | Covered |
| J84.841 | ICD10CM | Covered |
| J84.848 | ICD10CM | Covered |
| J84.89 | ICD10CM | Covered |
| J84.9 | ICD10CM | Covered |
| M81.0 | ICD10CM | Covered |
| M81.8 | ICD10CM | Covered |
| Q24.8 | ICD10CM | Covered |
| Q44.6 | ICD10CM | Covered |
| Q61.11 | ICD10CM | Covered |
| Q61.3 | ICD10CM | Covered |
| Q76.1 | ICD10CM | Covered |
| Q78.0 | ICD10CM | Covered |
| Q78.1 | ICD10CM | Covered |
| Q80.0 | ICD10CM | Covered |
| Q80.9 | ICD10CM | Covered |
| Q85.1 | ICD10CM | Covered |
| Q89.9 | ICD10CM | Covered |
| R26.0 | ICD10CM | Covered |
| R26.9 | ICD10CM | Covered |
| R42 | ICD10CM | Covered |
| R56.00 | ICD10CM | Covered |
| R56.01 | ICD10CM | Covered |
| R94.31 | ICD10CM | Covered |
| Z13.6 | ICD10CM | Covered |
| Z80.3 | ICD10CM | Covered |
| Z82.41 | ICD10CM | Covered |
| Z82.49 | ICD10CM | Covered |
| Z83.2 | ICD10CM | Covered |
| Z83.6 | ICD10CM | Covered |
| Z86.2 | ICD10CM | Covered |
| Z86.711 | ICD10CM | Covered |
| Z86.72 | ICD10CM | Covered |