Aetna · PayerPolicy · AETNA-CPB-0171
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 |
|---|---|---|
| 73218 | CPT | Covered |
| 73223 | CPT | Covered |
| 73718 | CPT | Covered |
| 73721 | CPT | Covered |
| 73723 | CPT | Covered |
| A11 | ICD10CM | Covered |
| A29 | ICD10CM | Covered |
| C49.20 | ICD10CM | Covered |
| C49.22 | ICD10CM | Covered |
| C76.50 | ICD10CM | Covered |
| C76.52 | ICD10CM | Covered |
| D21.20 | ICD10CM | Covered |
| D21.22 | ICD10CM | Covered |
| D48.0 | ICD10CM | Covered |
| G57.60 | ICD10CM | Covered |
| G57.63 | ICD10CM | Covered |
| G71.00 | ICD10CM | Covered |
| G71.09 | ICD10CM | Covered |
| M05.00 | ICD10CM | Covered |
| M14.89 | ICD10CM | Covered |
| M17.0 | ICD10CM | Covered |
| M17.9 | ICD10CM | Covered |
| M22.40 | ICD10CM | Covered |
| M22.42 | ICD10CM | Covered |
| M23. | ICD10CM | Covered |
| M23.000 | ICD10CM | Covered |
| M23.92 | ICD10CM | Covered |
| M25.261 | ICD10CM | Covered |
| M25.269 | ICD10CM | Covered |
| M25.361 | ICD10CM | Covered |
| M25.369 | ICD10CM | Covered |
| M25.461 | ICD10CM | Covered |
| M25.469 | ICD10CM | Covered |
| M25.561 | ICD10CM | Covered |
| M25.569 | ICD10CM | Covered |
| M79. | ICD10CM | Covered |
| M86. | ICD10CM | Covered |
| M86.361 | ICD10CM | Covered |
| M86.369 | ICD10CM | Covered |
| M86.461 | ICD10CM | Covered |
| M86.469 | ICD10CM | Covered |
| M86.561 | ICD10CM | Covered |
| M86.569 | ICD10CM | Covered |
| M86.661 | ICD10CM | Covered |
| M86.669 | ICD10CM | Covered |
| M87.051 | ICD10CM | Covered |
| M87.066 | ICD10CM | Covered |
| M87.151 | ICD10CM | Covered |
| M87.166 | ICD10CM | Covered |
| M87.251 | ICD10CM | Covered |
| M87.266 | ICD10CM | Covered |
| M87.351 | ICD10CM | Covered |
| M87.366 | ICD10CM | Covered |
| M87.851 | ICD10CM | Covered |
| M87.869 | ICD10CM | Covered |
| M93.261 | ICD10CM | Covered |
| M93.269 | ICD10CM | Covered |
| Q87.3 | ICD10CM | Covered |
| S13. | ICD10CM | Covered |
| S14. | ICD10CM | Covered |
| S24. | ICD10CM | Covered |
| S34. | ICD10CM | Covered |
| S34.139S | ICD10CM | Covered |
| S83.200 | ICD10CM | Covered |
| S83.289 | ICD10CM | Covered |
| T79. | ICD10CM | Covered |
| Z12.0 | ICD10CM | Covered |
| Z12.9 | ICD10CM | Covered |
| Z15.01 | ICD10CM | Covered |
| Z46.89 | ICD10CM | Covered |