Aetna · PayerPolicy · AETNA-CPB-0207
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 |
|---|---|---|
| 36465 | CPT | Covered |
| 36466 | CPT | Covered |
| 36468 | CPT | Covered |
| 36470 | CPT | Covered |
| 36471 | CPT | Covered |
| 43204 | CPT | Covered |
| 43243 | CPT | Covered |
| 45520 | CPT | Covered |
| 49185 | CPT | Covered |
| M0076 | HCPCS | Covered |
| B02.22 | ICD10CM | Covered |
| E04.1 | ICD10CM | Covered |
| E04.2 | ICD10CM | Covered |
| G57.60 | ICD10CM | Covered |
| G57.63 | ICD10CM | Covered |
| K62.3 | ICD10CM | Covered |
| L76.33 | ICD10CM | Covered |
| L76.34 | ICD10CM | Covered |
| M17.0 | ICD10CM | Covered |
| M17.9 | ICD10CM | Covered |
| M18.0 | ICD10CM | Covered |
| M18.9 | ICD10CM | Covered |
| M19.011 | ICD10CM | Covered |
| M19.019 | ICD10CM | Covered |
| M19.041 | ICD10CM | Covered |
| M19.049 | ICD10CM | Covered |
| M19.141 | ICD10CM | Covered |
| M19.149 | ICD10CM | Covered |
| M19.241 | ICD10CM | Covered |
| M19.249 | ICD10CM | Covered |
| M24.00 | ICD10CM | Covered |
| M24.176 | ICD10CM | Covered |
| M24.30 | ICD10CM | Covered |
| M24.9 | ICD10CM | Covered |
| M25.371 | ICD10CM | Covered |
| M25.373 | ICD10CM | Covered |
| M25.374 | ICD10CM | Covered |
| M25.376 | ICD10CM | Covered |
| M25.50 | ICD10CM | Covered |
| M25.51 | ICD10CM | Covered |
| M25.519 | ICD10CM | Covered |
| M25.59 | ICD10CM | Covered |
| M25.851 | ICD10CM | Covered |
| M25.859 | ICD10CM | Covered |
| M26.601 | ICD10CM | Covered |
| M26.69 | ICD10CM | Covered |
| M53. | ICD10CM | Covered |
| M53.3 | ICD10CM | Covered |
| M54.2 | ICD10CM | Covered |
| M54.5 | ICD10CM | Covered |
| M67.811 | ICD10CM | Covered |
| M67.819 | ICD10CM | Covered |
| M67.90 | ICD10CM | Covered |
| M67.99 | ICD10CM | Covered |
| M72.0 | ICD10CM | Covered |
| M72.9 | ICD10CM | Covered |
| M75.100 | ICD10CM | Covered |
| M75.122 | ICD10CM | Covered |
| M75.50 | ICD10CM | Covered |
| M75.52 | ICD10CM | Covered |
| M76.00 | ICD10CM | Covered |
| M76.02 | ICD10CM | Covered |
| M76.30 | ICD10CM | Covered |
| M76.32 | ICD10CM | Covered |
| M76.50 | ICD10CM | Covered |
| M76.52 | ICD10CM | Covered |
| M76.60 | ICD10CM | Covered |
| M76.62 | ICD10CM | Covered |
| M77.00 | ICD10CM | Covered |
| M77.12 | ICD10CM | Covered |
| M79.10 | ICD10CM | Covered |
| M79.18 | ICD10CM | Covered |
| M79.2 | ICD10CM | Covered |
| M85.50 | ICD10CM | Covered |
| M85.59 | ICD10CM | Covered |
| M86.18 | ICD10CM | Covered |
| M86.68 | ICD10CM | Covered |
| M92.50 | ICD10CM | Covered |
| M92.52 | ICD10CM | Covered |
| N28.1 | ICD10CM | Covered |
| N30.10 | ICD10CM | Covered |
| N30.11 | ICD10CM | Covered |
| N80.1 | ICD10CM | Covered |
| N83.291 | ICD10CM | Covered |
| N83.299 | ICD10CM | Covered |
| Q27.9 | ICD10CM | Covered |
| Q44.6 | ICD10CM | Covered |
| Q61.9 | ICD10CM | Covered |
| R39.82 | ICD10CM | Covered |
| S03. | ICD10CM | Covered |
| S13. | ICD10CM | Covered |
| S23. | ICD10CM | Covered |
| S33. | ICD10CM | Covered |
| S39. | ICD10CM | Covered |
| S43. | ICD10CM | Covered |
| S46. | ICD10CM | Covered |
| S53. | ICD10CM | Covered |
| S63. | ICD10CM | Covered |
| S73. | ICD10CM | Covered |
| S83. | ICD10CM | Covered |
| S93. | ICD10CM | Covered |
| T79. | ICD10CM | Covered |