Aetna · PayerPolicy · AETNA-CPB-0221
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 |
|---|---|---|
| 95812 | CPT | Covered |
| 95830 | CPT | Covered |
| 95961 | CPT | Covered |
| 95962 | CPT | Covered |
| S8040 | HCPCS | Covered |
| A81.00 | ICD10CM | Covered |
| A81.9 | ICD10CM | Covered |
| F02. | ICD10CM | Covered |
| F02.80 | ICD10CM | Covered |
| F03. | ICD10CM | Covered |
| F03.90 | ICD10CM | Covered |
| F06.1 | ICD10CM | Covered |
| F06.8 | ICD10CM | Covered |
| F07.81 | ICD10CM | Covered |
| F10.121 | ICD10CM | Covered |
| F10.14 | ICD10CM | Covered |
| F10.150 | ICD10CM | Covered |
| F10.159 | ICD10CM | Covered |
| F10.180 | ICD10CM | Covered |
| F10.19 | ICD10CM | Covered |
| F10.221 | ICD10CM | Covered |
| F10.230 | ICD10CM | Covered |
| F10.24 | ICD10CM | Covered |
| F10.250 | ICD10CM | Covered |
| F10.29 | ICD10CM | Covered |
| F10.920 | ICD10CM | Covered |
| F10.99 | ICD10CM | Covered |
| F11.10 | ICD10CM | Covered |
| F19.999 | ICD10CM | Covered |
| F20.0 | ICD10CM | Covered |
| F20.9 | ICD10CM | Covered |
| F25.0 | ICD10CM | Covered |
| F25.9 | ICD10CM | Covered |
| F30.10 | ICD10CM | Covered |
| F34.1 | ICD10CM | Covered |
| F39 | ICD10CM | Covered |
| F41.0 | ICD10CM | Covered |
| F41.9 | ICD10CM | Covered |
| F42.2 | ICD10CM | Covered |
| F42.9 | ICD10CM | Covered |
| F43.10 | ICD10CM | Covered |
| F43.12 | ICD10CM | Covered |
| F50.00 | ICD10CM | Covered |
| F50.9 | ICD10CM | Covered |
| F51.01 | ICD10CM | Covered |
| F51.03 | ICD10CM | Covered |
| F51.09 | ICD10CM | Covered |
| F80.0 | ICD10CM | Covered |
| F89 | ICD10CM | Covered |
| F90.0 | ICD10CM | Covered |
| F90.9 | ICD10CM | Covered |
| G20 | ICD10CM | Covered |
| G21.9 | ICD10CM | Covered |
| G40.00 | ICD10CM | Covered |
| G40.919 | ICD10CM | Covered |
| G47.00 | ICD10CM | Covered |
| G89.21 | ICD10CM | Covered |
| G89.29 | ICD10CM | Covered |
| G92.00 | ICD10CM | Covered |
| G92.9 | ICD10CM | Covered |
| G93.1 | ICD10CM | Covered |
| G93.40 | ICD10CM | Covered |
| G93.49 | ICD10CM | Covered |
| G97.31 | ICD10CM | Covered |
| G97.32 | ICD10CM | Covered |
| H93. | ICD10CM | Covered |
| H93.11 | ICD10CM | Covered |
| H93.9 | ICD10CM | Covered |
| J12.82 | ICD10CM | Covered |
| M79.7 | ICD10CM | Covered |
| P07.30 | ICD10CM | Covered |
| P07.39 | ICD10CM | Covered |
| P29.81 | ICD10CM | Covered |
| P91.60 | ICD10CM | Covered |
| P91.819 | ICD10CM | Covered |
| Q00.0 | ICD10CM | Covered |
| Q07.9 | ICD10CM | Covered |
| R40.3 | ICD10CM | Covered |
| R48.0 | ICD10CM | Covered |
| R56.1 | ICD10CM | Covered |
| R56.9 | ICD10CM | Covered |
| S06. | ICD10CM | Covered |
| S09. | ICD10CM | Covered |
| T56. | ICD10CM | Covered |
| W21.00 | ICD10CM | Covered |
| W21.9 | ICD10CM | Covered |
| Z13.31 | ICD10CM | Covered |
| Z73.810 | ICD10CM | Covered |
| Z73.819 | ICD10CM | Covered |
| Z86.73 | ICD10CM | Covered |
| Z86.74 | ICD10CM | Covered |