Aetna · PayerPolicy · AETNA-CPB-0210
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 |
|---|---|---|
| 97035 | CPT | Covered |
| A18.2 | ICD10CM | Covered |
| G56.00 | ICD10CM | Covered |
| G56.03 | ICD10CM | Covered |
| H65.00 | ICD10CM | Covered |
| H65.07 | ICD10CM | Covered |
| H65.20 | ICD10CM | Covered |
| H65.23 | ICD10CM | Covered |
| J01.00 | ICD10CM | Covered |
| J01.91 | ICD10CM | Covered |
| J32.0 | ICD10CM | Covered |
| J32.9 | ICD10CM | Covered |
| J44.0 | ICD10CM | Covered |
| J44.9 | ICD10CM | Covered |
| M17.0 | ICD10CM | Covered |
| M17.9 | ICD10CM | Covered |
| M19.031 | ICD10CM | Covered |
| M19.039 | ICD10CM | Covered |
| M25.521 | ICD10CM | Covered |
| M25.529 | ICD10CM | Covered |
| M25.561 | ICD10CM | Covered |
| M25.569 | ICD10CM | Covered |
| M26.601 | ICD10CM | Covered |
| M26.69 | ICD10CM | Covered |
| M54.2 | ICD10CM | Covered |
| M54.50 | ICD10CM | Covered |
| M54.59 | ICD10CM | Covered |
| M61.00 | ICD10CM | Covered |
| M61.19 | ICD10CM | Covered |
| M75.00 | ICD10CM | Covered |
| M75.02 | ICD10CM | Covered |
| M75.40 | ICD10CM | Covered |
| M75.42 | ICD10CM | Covered |
| M75.80 | ICD10CM | Covered |
| M75.82 | ICD10CM | Covered |
| M76.30 | ICD10CM | Covered |
| M76.32 | ICD10CM | Covered |
| M79.18 | ICD10CM | Covered |
| N41.1 | ICD10CM | Covered |
| S09. | ICD10CM | Covered |
| S16. | ICD10CM | Covered |
| S29.091A | ICD10CM | Covered |
| S29.099S | ICD10CM | Covered |
| S39.091A | ICD10CM | Covered |
| S39.093S | ICD10CM | Covered |
| S46.091A | ICD10CM | Covered |
| S46.099S | ICD10CM | Covered |
| S46.191A | ICD10CM | Covered |
| S46.199S | ICD10CM | Covered |
| S46.291A | ICD10CM | Covered |
| S46.299S | ICD10CM | Covered |
| S46.391A | ICD10CM | Covered |
| S46.399S | ICD10CM | Covered |
| S46.891A | ICD10CM | Covered |
| S46.899S | ICD10CM | Covered |
| S46.991A | ICD10CM | Covered |
| S46.999S | ICD10CM | Covered |
| S56.091A | ICD10CM | Covered |
| S56.099S | ICD10CM | Covered |
| S56.191A | ICD10CM | Covered |
| S56.199S | ICD10CM | Covered |
| S56.291A | ICD10CM | Covered |
| S56.299S | ICD10CM | Covered |
| S56.391A | ICD10CM | Covered |
| S56.399S | ICD10CM | Covered |
| S56.491A | ICD10CM | Covered |
| S56.499S | ICD10CM | Covered |
| S56.591A | ICD10CM | Covered |
| S56.599S | ICD10CM | Covered |
| S56.891A | ICD10CM | Covered |
| S56.899S | ICD10CM | Covered |
| S56.991A | ICD10CM | Covered |
| S56.999S | ICD10CM | Covered |
| S66.091A | ICD10CM | Covered |
| S66.099S | ICD10CM | Covered |
| S66.190A | ICD10CM | Covered |
| S66.199S | ICD10CM | Covered |
| S66.291A | ICD10CM | Covered |
| S66.299S | ICD10CM | Covered |
| S66.390A | ICD10CM | Covered |
| S66.399S | ICD10CM | Covered |
| S66.491A | ICD10CM | Covered |
| S66.499S | ICD10CM | Covered |
| S66.590A | ICD10CM | Covered |
| S66.599S | ICD10CM | Covered |
| S66.891A | ICD10CM | Covered |
| S66.899S | ICD10CM | Covered |
| S66.991A | ICD10CM | Covered |
| S66.999S | ICD10CM | Covered |
| S76.091A | ICD10CM | Covered |
| S76.099S | ICD10CM | Covered |
| S76.191A | ICD10CM | Covered |
| S76.199S | ICD10CM | Covered |
| S76.291A | ICD10CM | Covered |
| S76.299S | ICD10CM | Covered |
| S76.391A | ICD10CM | Covered |
| S76.399S | ICD10CM | Covered |
| S76.891A | ICD10CM | Covered |
| S76.899S | ICD10CM | Covered |
| S76.991A | ICD10CM | Covered |
| S76.999S | ICD10CM | Covered |
| S86.091A | ICD10CM | Covered |
| S86.099S | ICD10CM | Covered |
| S86.191A | ICD10CM | Covered |
| S86.199S | ICD10CM | Covered |
| S86.291A | ICD10CM | Covered |
| S86.299S | ICD10CM | Covered |
| S86.391A | ICD10CM | Covered |
| S86.399S | ICD10CM | Covered |
| S86.891A | ICD10CM | Covered |
| S86.899S | ICD10CM | Covered |
| S86.991A | ICD10CM | Covered |
| S86.999S | ICD10CM | Covered |
| S96.091A | ICD10CM | Covered |
| S96.099S | ICD10CM | Covered |
| S96.191A | ICD10CM | Covered |
| S96.199S | ICD10CM | Covered |
| S96.291A | ICD10CM | Covered |
| S96.299S | ICD10CM | Covered |
| S96.891A | ICD10CM | Covered |
| S96.899S | ICD10CM | Covered |
| S96.991A | ICD10CM | Covered |
| S96.999S | ICD10CM | Covered |