Aetna · PayerPolicy · AETNA-CPB-0243
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 |
|---|---|---|
| 92507 | CPT | Covered |
| 92508 | CPT | Covered |
| 92521 | CPT | Covered |
| 92522 | CPT | Covered |
| 92523 | CPT | Covered |
| 92524 | CPT | Covered |
| 92526 | CPT | Covered |
| 92630 | CPT | Covered |
| 92633 | CPT | Covered |
| 97014 | CPT | Covered |
| 97032 | CPT | Covered |
| 97535 | CPT | Covered |
| G0153 | HCPCS | Covered |
| G0161 | HCPCS | Covered |
| S9128 | HCPCS | Covered |
| S9152 | HCPCS | Covered |
| C00.0 | ICD10CM | Covered |
| C00.9 | ICD10CM | Covered |
| C01 | ICD10CM | Covered |
| C02.9 | ICD10CM | Covered |
| C03.0 | ICD10CM | Covered |
| C03.9 | ICD10CM | Covered |
| C04.0 | ICD10CM | Covered |
| C04.9 | ICD10CM | Covered |
| C05.0 | ICD10CM | Covered |
| C05.9 | ICD10CM | Covered |
| C06.0 | ICD10CM | Covered |
| C06.9 | ICD10CM | Covered |
| C08.0 | ICD10CM | Covered |
| C08.9 | ICD10CM | Covered |
| C10.0 | ICD10CM | Covered |
| C10.9 | ICD10CM | Covered |
| C11.0 | ICD10CM | Covered |
| C11.9 | ICD10CM | Covered |
| C13.0 | ICD10CM | Covered |
| C13.9 | ICD10CM | Covered |
| C14.0 | ICD10CM | Covered |
| C14.8 | ICD10CM | Covered |
| C32.0 | ICD10CM | Covered |
| C32.9 | ICD10CM | Covered |
| C71.0 | ICD10CM | Covered |
| C71.9 | ICD10CM | Covered |
| D02.0 | ICD10CM | Covered |
| D14.1 | ICD10CM | Covered |
| E74.02 | ICD10CM | Covered |
| F44.4 | ICD10CM | Covered |
| F80.0 | ICD10CM | Covered |
| F80.9 | ICD10CM | Covered |
| G25.2 | ICD10CM | Covered |
| G45.0 | ICD10CM | Covered |
| G45.9 | ICD10CM | Covered |
| G46.0 | ICD10CM | Covered |
| G46.8 | ICD10CM | Covered |
| H93.25 | ICD10CM | Covered |
| J38.00 | ICD10CM | Covered |
| J38.02 | ICD10CM | Covered |
| J38.2 | ICD10CM | Covered |
| Q31.0 | ICD10CM | Covered |
| Q31.8 | ICD10CM | Covered |
| Q31.9 | ICD10CM | Covered |
| Q32.0 | ICD10CM | Covered |
| Q32.1 | ICD10CM | Covered |
| Q32.2 | ICD10CM | Covered |
| Q32.3 | ICD10CM | Covered |
| Q32.4 | ICD10CM | Covered |
| Q35.1 | ICD10CM | Covered |
| Q37.9 | ICD10CM | Covered |
| R05 | ICD10CM | Covered |
| R13.10 | ICD10CM | Covered |
| R13.19 | ICD10CM | Covered |
| R49.0 | ICD10CM | Covered |
| S01.501A | ICD10CM | Covered |
| S01.552S | ICD10CM | Covered |
| S02. | ICD10CM | Covered |
| S04.011S | ICD10CM | Covered |
| S04.899S | ICD10CM | Covered |
| S06. | ICD10CM | Covered |
| S11.011 | ICD10CM | Covered |
| S11.029 | ICD10CM | Covered |
| Z85.21 | ICD10CM | Covered |
| Z85.810 | ICD10CM | Covered |
| Z85.818 | ICD10CM | Covered |
| Z85.819 | ICD10CM | Covered |
| Z96.20 | ICD10CM | Covered |
| Z96.21 | ICD10CM | Covered |
| Z96.3 | ICD10CM | Covered |