Aetna · PayerPolicy · AETNA-CPB-0229
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 |
|---|---|---|
| 89230 | CPT | Covered |
| 97033 | CPT | Covered |
| J3285 | HCPCS | Covered |
| J7686 | HCPCS | Covered |
| B00.50 | ICD10CM | Covered |
| B00.59 | ICD10CM | Covered |
| E08.621 | ICD10CM | Covered |
| E08.622 | ICD10CM | Covered |
| E09.621 | ICD10CM | Covered |
| E09.622 | ICD10CM | Covered |
| E10.621 | ICD10CM | Covered |
| E10.622 | ICD10CM | Covered |
| E11.621 | ICD10CM | Covered |
| E11.622 | ICD10CM | Covered |
| E13.621 | ICD10CM | Covered |
| E13.622 | ICD10CM | Covered |
| E84.0 | ICD10CM | Covered |
| E84.9 | ICD10CM | Covered |
| G56.00 | ICD10CM | Covered |
| G56.03 | ICD10CM | Covered |
| G89.12 | ICD10CM | Covered |
| G89.18 | ICD10CM | Covered |
| H52.10 | ICD10CM | Covered |
| H52.13 | ICD10CM | Covered |
| H61.031 | ICD10CM | Covered |
| H61.039 | ICD10CM | Covered |
| H93. | ICD10CM | Covered |
| H93.11 | ICD10CM | Covered |
| H93.19 | ICD10CM | Covered |
| L40.3 | ICD10CM | Covered |
| L74.510 | ICD10CM | Covered |
| L74.519 | ICD10CM | Covered |
| L74.52 | ICD10CM | Covered |
| L81.0 | ICD10CM | Covered |
| L81.4 | ICD10CM | Covered |
| L81.8 | ICD10CM | Covered |
| L90.2 | ICD10CM | Covered |
| M00.00 | ICD10CM | Covered |
| M77.00 | ICD10CM | Covered |
| M77.12 | ICD10CM | Covered |
| M77.30 | ICD10CM | Covered |
| M77.32 | ICD10CM | Covered |
| M79.671 | ICD10CM | Covered |
| M79.673 | ICD10CM | Covered |
| M99.9 | ICD10CM | Covered |
| N48.6 | ICD10CM | Covered |
| R61 | ICD10CM | Covered |
| S14.101A | ICD10CM | Covered |
| S14.109S | ICD10CM | Covered |
| S24.101A | ICD10CM | Covered |
| S24.109S | ICD10CM | Covered |
| S34.101A | ICD10CM | Covered |
| S34.109S | ICD10CM | Covered |
| S34.139A | ICD10CM | Covered |
| S34.139S | ICD10CM | Covered |
| S83. | ICD10CM | Covered |
| S83.401A | ICD10CM | Covered |
| Z13.228 | ICD10CM | Covered |
| Z13.6 | ICD10CM | Covered |
| Z79.1 | ICD10CM | Covered |
| Z79.51 | ICD10CM | Covered |
| Z79.52 | ICD10CM | Covered |