Aetna · PayerPolicy · AETNA-CPB-0241
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 |
|---|---|---|
| 36522 | CPT | Covered |
| B12 | ICD10CM | Covered |
| C84. | ICD10CM | Covered |
| C84.00 | ICD10CM | Covered |
| C84.09 | ICD10CM | Covered |
| C84.10 | ICD10CM | Covered |
| C84.19 | ICD10CM | Covered |
| D51.0 | ICD10CM | Covered |
| D59.0 | ICD10CM | Covered |
| D59.1 | ICD10CM | Covered |
| D69.0 | ICD10CM | Covered |
| D69.3 | ICD10CM | Covered |
| D76.3 | ICD10CM | Covered |
| D89.810 | ICD10CM | Covered |
| D89.813 | ICD10CM | Covered |
| E10.10 | ICD10CM | Covered |
| E11.9 | ICD10CM | Covered |
| E13.00 | ICD10CM | Covered |
| E13.9 | ICD10CM | Covered |
| G35 | ICD10CM | Covered |
| G61.0 | ICD10CM | Covered |
| G70.00 | ICD10CM | Covered |
| G70.01 | ICD10CM | Covered |
| J42 | ICD10CM | Covered |
| K50.00 | ICD10CM | Covered |
| K50.919 | ICD10CM | Covered |
| K52.1 | ICD10CM | Covered |
| L10.0 | ICD10CM | Covered |
| L10.9 | ICD10CM | Covered |
| L12.0 | ICD10CM | Covered |
| L12.9 | ICD10CM | Covered |
| L20.0 | ICD10CM | Covered |
| L20.9 | ICD10CM | Covered |
| L44.0 | ICD10CM | Covered |
| L94.0 | ICD10CM | Covered |
| M32.0 | ICD10CM | Covered |
| M32.9 | ICD10CM | Covered |
| M34.0 | ICD10CM | Covered |
| M34.9 | ICD10CM | Covered |
| M35.4 | ICD10CM | Covered |
| T86.00 | ICD10CM | Covered |
| T86.09 | ICD10CM | Covered |
| T86.10 | ICD10CM | Covered |
| T86.19 | ICD10CM | Covered |
| T86.20 | ICD10CM | Covered |
| T86.39 | ICD10CM | Covered |
| T86.40 | ICD10CM | Covered |
| T86.49 | ICD10CM | Covered |
| T86.810 | ICD10CM | Covered |
| T86.819 | ICD10CM | Covered |
| Z94. | ICD10CM | Covered |
| Z94.0 | ICD10CM | Covered |
| Z94.1 | ICD10CM | Covered |
| Z94.2 | ICD10CM | Covered |
| Z94.4 | ICD10CM | Covered |
| Z94.81 | ICD10CM | Covered |
| Z94.84 | ICD10CM | Covered |