Aetna · PayerPolicy · AETNA-CPB-0293
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 |
|---|---|---|
| 65778 | CPT | Covered |
| 65779 | CPT | Covered |
| 65780 | CPT | Covered |
| 65781 | CPT | Covered |
| 65782 | CPT | Covered |
| V2790 | HCPCS | Covered |
| D31.10 | ICD10CM | Covered |
| D31.12 | ICD10CM | Covered |
| E08.3521 | ICD10CM | Covered |
| E08.3549 | ICD10CM | Covered |
| E09.3521 | ICD10CM | Covered |
| E09.3549 | ICD10CM | Covered |
| E10.3521 | ICD10CM | Covered |
| E10.3549 | ICD10CM | Covered |
| E11.3521 | ICD10CM | Covered |
| E11.3549 | ICD10CM | Covered |
|---|
| E13.3521 | ICD10CM | Covered |
|---|
| E13.3549 | ICD10CM | Covered |
|---|
| H11.001 | ICD10CM | Covered |
|---|
| H11.069 | ICD10CM | Covered |
|---|
| H11.811 | ICD10CM | Covered |
|---|
| H11.829 | ICD10CM | Covered |
|---|
| H15.001 | ICD10CM | Covered |
|---|
| H15.099 | ICD10CM | Covered |
|---|
| H16.001 | ICD10CM | Covered |
|---|
| H16.079 | ICD10CM | Covered |
|---|
| H16.231 | ICD10CM | Covered |
|---|
| H16.239 | ICD10CM | Covered |
|---|
| H16.8 | ICD10CM | Covered |
|---|
| H18.10 | ICD10CM | Covered |
|---|
| H18.13 | ICD10CM | Covered |
|---|
| H18.40 | ICD10CM | Covered |
|---|
| H18.49 | ICD10CM | Covered |
|---|
| H18.50 | ICD10CM | Covered |
|---|
| H18.59 | ICD10CM | Covered |
|---|
| H18.821 | ICD10CM | Covered |
|---|
| H18.829 | ICD10CM | Covered |
|---|
| H18.891 | ICD10CM | Covered |
|---|
| H18.899 | ICD10CM | Covered |
|---|
| H33.001 | ICD10CM | Covered |
|---|
| H33.8 | ICD10CM | Covered |
|---|
| H35.30 | ICD10CM | Covered |
|---|
| H35.3293 | ICD10CM | Covered |
|---|
| H35.341 | ICD10CM | Covered |
|---|
| H35.349 | ICD10CM | Covered |
|---|
| H35.721 | ICD10CM | Covered |
|---|
| H35.729 | ICD10CM | Covered |
|---|
| H35.731 | ICD10CM | Covered |
|---|
| H35.739 | ICD10CM | Covered |
|---|
| H40.1110 | ICD10CM | Covered |
|---|
| H40.1194 | ICD10CM | Covered |
|---|
| H44. | ICD10CM | Covered |
|---|
| H50.0 | ICD10CM | Covered |
|---|
| H50.9 | ICD10CM | Covered |
|---|
| L51.1 | ICD10CM | Covered |
|---|
| Q13.1 | ICD10CM | Covered |
|---|
| T26. | ICD10CM | Covered |
|---|
| Z94.7 | ICD10CM | Covered |
|---|