Aetna · PayerPolicy · AETNA-CPB-0175
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 |
|---|---|---|
| 97014 | CPT | Covered |
| 97024 | CPT | Covered |
| 97032 | CPT | Covered |
| E0761 | HCPCS | Covered |
| G0281 | HCPCS | Covered |
| G0283 | HCPCS | Covered |
| G0295 | HCPCS | Covered |
| G0329 | HCPCS | Covered |
| C00.0 | ICD10CM | Covered |
| C96.9 | ICD10CM | Covered |
| E08.40 | ICD10CM | Covered |
| E08.49 | ICD10CM | Covered |
| E09.40 | ICD10CM | Covered |
| E09.49 | ICD10CM | Covered |
| E10.40 | ICD10CM | Covered |
| E10.49 | ICD10CM | Covered |
| E11.40 | ICD10CM | Covered |
| E11.49 | ICD10CM | Covered |
| E13.40 | ICD10CM | Covered |
| E13.49 | ICD10CM | Covered |
| G20. | ICD10CM | Covered |
| G20.C | ICD10CM | Covered |
| G21.0 | ICD10CM | Covered |
| G21.9 | ICD10CM | Covered |
| G25.0 | ICD10CM | Covered |
| G25.2 | ICD10CM | Covered |
| G35 | ICD10CM | Covered |
| G56.00 | ICD10CM | Covered |
| G59 | ICD10CM | Covered |
| G89.29 | ICD10CM | Covered |
| G89.4 | ICD10CM | Covered |
| L89.000 | ICD10CM | Covered |
| L89.95 | ICD10CM | Covered |
| M15.0 | ICD10CM | Covered |
| M19.93 | ICD10CM | Covered |
| M20.10 | ICD10CM | Covered |
| M20.12 | ICD10CM | Covered |
| M48.01 | ICD10CM | Covered |
| M48.03 | ICD10CM | Covered |
| M50.00 | ICD10CM | Covered |
| M51. | ICD10CM | Covered |
| M51.9 | ICD10CM | Covered |
| M54.10 | ICD10CM | Covered |
| M54.18 | ICD10CM | Covered |
| M54.30 | ICD10CM | Covered |
| M54.32 | ICD10CM | Covered |
| M54.40 | ICD10CM | Covered |
| M54.42 | ICD10CM | Covered |
| M54.50 | ICD10CM | Covered |
| M60.000 | ICD10CM | Covered |
| M63.89 | ICD10CM | Covered |
| M66.0 | ICD10CM | Covered |
| M66.9 | ICD10CM | Covered |
| M67.90 | ICD10CM | Covered |
| M67.99 | ICD10CM | Covered |
| M70.031 | ICD10CM | Covered |
| M70.039 | ICD10CM | Covered |
| M71.011 | ICD10CM | Covered |
| M71.9 | ICD10CM | Covered |
| M77.00 | ICD10CM | Covered |
| M77.02 | ICD10CM | Covered |
| M77.10 | ICD10CM | Covered |
| M77.12 | ICD10CM | Covered |
| M79.10 | ICD10CM | Covered |
| M79.18 | ICD10CM | Covered |
| M79.2 | ICD10CM | Covered |
| M79.7 | ICD10CM | Covered |
| M81.0 | ICD10CM | Covered |
| M81.8 | ICD10CM | Covered |
| M87.08 | ICD10CM | Covered |
| M96.621 | ICD10CM | Covered |
| M96.69 | ICD10CM | Covered |
| M97. | ICD10CM | Covered |
| M99.20 | ICD10CM | Covered |
| M99.21 | ICD10CM | Covered |
| M99.30 | ICD10CM | Covered |
| M99.31 | ICD10CM | Covered |
| M99.40 | ICD10CM | Covered |
| M99.41 | ICD10CM | Covered |
| M99.50 | ICD10CM | Covered |
| M99.51 | ICD10CM | Covered |
| M99.60 | ICD10CM | Covered |
| M99.61 | ICD10CM | Covered |
| M99.70 | ICD10CM | Covered |
| M99.71 | ICD10CM | Covered |
| R25.2 | ICD10CM | Covered |
| R60.0 | ICD10CM | Covered |
| R60.9 | ICD10CM | Covered |
| S02. | ICD10CM | Covered |
| S12. | ICD10CM | Covered |
| S12.000A | ICD10CM | Covered |
| S22. | ICD10CM | Covered |
| S22.000A | ICD10CM | Covered |
| S32. | ICD10CM | Covered |
| S32.000A | ICD10CM | Covered |
| S42. | ICD10CM | Covered |
| S42.001A | ICD10CM | Covered |
| S52. | ICD10CM | Covered |
| S52.001A | ICD10CM | Covered |
| S62. | ICD10CM | Covered |
| S62.001A | ICD10CM | Covered |
| S72. | ICD10CM | Covered |
| S72.001A | ICD10CM | Covered |
| S82. | ICD10CM | Covered |
| S82.001A | ICD10CM | Covered |
| S92.001A | ICD10CM | Covered |
| S92.919S | ICD10CM | Covered |
| T85.613A | ICD10CM | Covered |
| T85.623S | ICD10CM | Covered |
| T85.693A | ICD10CM | Covered |
| T85.693S | ICD10CM | Covered |
| T86.820 | ICD10CM | Covered |
| T86.829 | ICD10CM | Covered |
| Z94.5 | ICD10CM | Covered |