Aetna · PayerPolicy · AETNA-CPB-0244
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 |
|---|---|---|
| 10040 | CPT | Covered |
| 11950 | CPT | Covered |
| 11954 | CPT | Covered |
| 11960 | CPT | Covered |
| 15150 | CPT | Covered |
| 15157 | CPT | Covered |
| 15769 | CPT | Covered |
| 15770 | CPT | Covered |
| 15771 | CPT | Covered |
| 15772 | CPT | Covered |
| 15773 | CPT | Covered |
| 15774 | CPT | Covered |
| 15877 | CPT | Covered |
| 23405 | CPT | Covered |
| 23406 | CPT | Covered |
| 24300 | CPT | Covered |
| 24342 | CPT | Covered |
| 24357 | CPT | Covered |
| 24359 | CPT | Covered |
| 25109 | CPT | Covered |
| 25260 | CPT | Covered |
| 25316 | CPT | Covered |
| 26060 | CPT | Covered |
| 26170 | CPT | Covered |
| 26180 | CPT | Covered |
| 26350 | CPT | Covered |
| 26502 | CPT | Covered |
| 26510 | CPT | Covered |
| 27000 | CPT | Covered |
| 27006 | CPT | Covered |
| 27097 | CPT | Covered |
| 27098 | CPT | Covered |
| 27306 | CPT | Covered |
| 27307 | CPT | Covered |
| 27380 | CPT | Covered |
| 27400 | CPT | Covered |
| 27605 | CPT | Covered |
| 27606 | CPT | Covered |
| 27650 | CPT | Covered |
| 27692 | CPT | Covered |
| 28010 | CPT | Covered |
| 28011 | CPT | Covered |
| 28200 | CPT | Covered |
| 28262 | CPT | Covered |
| 29806 | CPT | Covered |
| 29828 | CPT | Covered |
| 29999 | CPT | Covered |
| 64912 | CPT | Covered |
| 64913 | CPT | Covered |
| 96372 | CPT | Covered |
| 97032 | CPT | Covered |
| A2001 | HCPCS | Covered |
| A2002 | HCPCS | Covered |
| A2003 | HCPCS | Covered |
| A2004 | HCPCS | Covered |
| A2005 | HCPCS | Covered |
| A2006 | HCPCS | Covered |
| A2007 | HCPCS | Covered |
| A2008 | HCPCS | Covered |
| A2009 | HCPCS | Covered |
| A2010 | HCPCS | Covered |
| A2011 | HCPCS | Covered |
| A2012 | HCPCS | Covered |
| A2013 | HCPCS | Covered |
| A2014 | HCPCS | Covered |
| A2015 | HCPCS | Covered |
| A2016 | HCPCS | Covered |
| A2017 | HCPCS | Covered |
| A2018 | HCPCS | Covered |
| A2019 | HCPCS | Covered |
| A2020 | HCPCS | Covered |
| A2021 | HCPCS | Covered |
| A2022 | HCPCS | Covered |
| A2023 | HCPCS | Covered |
| A2024 | HCPCS | Covered |
| A2025 | HCPCS | Covered |
| A2027 | HCPCS | Covered |
| A2028 | HCPCS | Covered |
| A2029 | HCPCS | Covered |
| A2030 | HCPCS | Covered |
| A2031 | HCPCS | Covered |
| A2032 | HCPCS | Covered |
| A2034 | HCPCS | Covered |
| A2035 | HCPCS | Covered |
| A4100 | HCPCS | Covered |
| A4575 | HCPCS | Covered |
| A6196 | HCPCS | Covered |
| A6199 | HCPCS | Covered |
| A6206 | HCPCS | Covered |
| A6208 | HCPCS | Covered |
| A6209 | HCPCS | Covered |
| A6211 | HCPCS | Covered |
| C1762 | HCPCS | Covered |
| C1781 | HCPCS | Covered |
| C1832 | HCPCS | Covered |
| C8002 | HCPCS | Covered |
| C9250 | HCPCS | Covered |
| C9352 | HCPCS | Covered |
| C9353 | HCPCS | Covered |
| C9354 | HCPCS | Covered |
| C9356 | HCPCS | Covered |
| C9358 | HCPCS | Covered |
| C9360 | HCPCS | Covered |
| C9364 | HCPCS | Covered |
| C9796 | HCPCS | Covered |
| G0281 | HCPCS | Covered |
| G0282 | HCPCS | Covered |
| G0428 | HCPCS | Covered |
| L8658 | HCPCS | Covered |
| P9020 | HCPCS | Covered |
| P9022 | HCPCS | Covered |
| Q4100 | HCPCS | Covered |
| Q4102 | HCPCS | Covered |
| Q4103 | HCPCS | Covered |
| Q4107 | HCPCS | Covered |
| Q4108 | HCPCS | Covered |
| Q4110 | HCPCS | Covered |
| Q4111 | HCPCS | Covered |
| Q4112 | HCPCS | Covered |
| Q4113 | HCPCS | Covered |
| Q4114 | HCPCS | Covered |
| Q4115 | HCPCS | Covered |
| Q4117 | HCPCS | Covered |
| Q4118 | HCPCS | Covered |
| Q4121 | HCPCS | Covered |
| Q4123 | HCPCS | Covered |
| Q4124 | HCPCS | Covered |
| Q4125 | HCPCS | Covered |
| Q4128 | HCPCS | Covered |
| Q4130 | HCPCS | Covered |
| Q4132 | HCPCS | Covered |
| Q4133 | HCPCS | Covered |
| Q4151 | HCPCS | Covered |
| Q4168 | HCPCS | Covered |
| Q4186 | HCPCS | Covered |
| Q4187 | HCPCS | Covered |
| Q4382 | HCPCS | Covered |
| S9055 | HCPCS | Covered |
| A2003 | ICD10CM | Covered |
| C44.42 | ICD10CM | Covered |
| C9250 | ICD10CM | Covered |
| E08.621 | ICD10CM | Covered |
| E09.621 | ICD10CM | Covered |
| E10.621 | ICD10CM | Covered |
| E11.621 | ICD10CM | Covered |
| E13.621 | ICD10CM | Covered |
| G96.00 | ICD10CM | Covered |
| G96.09 | ICD10CM | Covered |
| H18.821 | ICD10CM | Covered |
| H18.829 | ICD10CM | Covered |
| J34.89 | ICD10CM | Covered |
| K210580 | ICD10CM | Covered |
| K211972 | ICD10CM | Covered |
| K40.00 | ICD10CM | Covered |
| K43.0 | ICD10CM | Covered |
| K43.9 | ICD10CM | Covered |
| K46.9 | ICD10CM | Covered |
| K56.1 | ICD10CM | Covered |
| K60.40 | ICD10CM | Covered |
| K60.429 | ICD10CM | Covered |
| K62.3 | ICD10CM | Covered |
| L03.011 | ICD10CM | Covered |
| L03.91 | ICD10CM | Covered |
| L74.52 | ICD10CM | Covered |
| L89.000 | ICD10CM | Covered |
| L89.95 | ICD10CM | Covered |
| L89.96 | ICD10CM | Covered |
| L90.5 | ICD10CM | Covered |
| L91.0 | ICD10CM | Covered |
| L95.8 | ICD10CM | Covered |
| L97.101 | ICD10CM | Covered |
| L97.929 | ICD10CM | Covered |
| M14.60 | ICD10CM | Covered |
| M14.69 | ICD10CM | Covered |
| M18.0 | ICD10CM | Covered |
| M18.12 | ICD10CM | Covered |
| M18.2 | ICD10CM | Covered |
| M18.52 | ICD10CM | Covered |
| M19.041 | ICD10CM | Covered |
| M19.049 | ICD10CM | Covered |
| M19.141 | ICD10CM | Covered |
| M19.149 | ICD10CM | Covered |
| M19.241 | ICD10CM | Covered |
| M19.249 | ICD10CM | Covered |
| M23.50 | ICD10CM | Covered |
| M23.52 | ICD10CM | Covered |
| M24.811 | ICD10CM | Covered |
| M24.819 | ICD10CM | Covered |
| M25.211 | ICD10CM | Covered |
| M25.219 | ICD10CM | Covered |
| M25.311 | ICD10CM | Covered |
| M25.319 | ICD10CM | Covered |
| M27.2 | ICD10CM | Covered |
| M66.211 | ICD10CM | Covered |
| M66.219 | ICD10CM | Covered |
| M66.811 | ICD10CM | Covered |
| M66.819 | ICD10CM | Covered |
| M75.100 | ICD10CM | Covered |
| M75.122 | ICD10CM | Covered |
| M75.50 | ICD10CM | Covered |
| M75.52 | ICD10CM | Covered |
| N81.0 | ICD10CM | Covered |
| N81.6 | ICD10CM | Covered |
| N81.9 | ICD10CM | Covered |
| S05. | ICD10CM | Covered |
| S31.100A | ICD10CM | Covered |
| S31.839S | ICD10CM | Covered |
| S41.001A | ICD10CM | Covered |
| S41.009S | ICD10CM | Covered |
| S43.101A | ICD10CM | Covered |
| S43.101S | ICD10CM | Covered |
| S43.421A | ICD10CM | Covered |
| S43.429S | ICD10CM | Covered |
| S83.501A | ICD10CM | Covered |
| S83.529S | ICD10CM | Covered |
| T20. | ICD10CM | Covered |
| T20.011A | ICD10CM | Covered |
| T20.311A | ICD10CM | Covered |
| T20.711A | ICD10CM | Covered |
| T21. | ICD10CM | Covered |
| T22. | ICD10CM | Covered |
| T22.399A | ICD10CM | Covered |
| T22.711A | ICD10CM | Covered |
| T22.799S | ICD10CM | Covered |
| T23.301A | ICD10CM | Covered |
| T23.399S | ICD10CM | Covered |
| T23.701A | ICD10CM | Covered |
| T23.799S | ICD10CM | Covered |
| T24.301A | ICD10CM | Covered |
| T24.399S | ICD10CM | Covered |
| T24.701A | ICD10CM | Covered |
| T24.799S | ICD10CM | Covered |
| T25.311A | ICD10CM | Covered |
| T25.399S | ICD10CM | Covered |
| T25.711A | ICD10CM | Covered |
| T25.799S | ICD10CM | Covered |
| T31.30 | ICD10CM | Covered |
| T31.99 | ICD10CM | Covered |
| T32.30 | ICD10CM | Covered |
| T32.99 | ICD10CM | Covered |
| T78. | ICD10CM | Covered |
| Z72.0 | ICD10CM | Covered |
| Z80.3 | ICD10CM | Covered |
| Z80.41 | ICD10CM | Covered |
| Z85.3 | ICD10CM | Covered |
| Z87.730 | ICD10CM | Covered |
| Z90.10 | ICD10CM | Covered |
| Z90.13 | ICD10CM | Covered |
| Z92.3 | ICD10CM | Covered |