Aetna · PayerPolicy · AETNA-CPB-0304
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 |
|---|---|---|
| 37617 | CPT | Covered |
| 58140 | CPT | Covered |
| 58146 | CPT | Covered |
| 58150 | CPT | Covered |
| 58294 | CPT | Covered |
| 58353 | CPT | Covered |
| 58356 | CPT | Covered |
| 58541 | CPT | Covered |
| 58544 | CPT | Covered |
| 58545 | CPT | Covered |
| 58546 | CPT | Covered |
| 58548 | CPT | Covered |
| 58550 | CPT | Covered |
| 58554 | CPT | Covered |
| 58570 | CPT | Covered |
| 58573 | CPT | Covered |
| 58953 | CPT | Covered |
| 58954 | CPT | Covered |
| 58956 | CPT | Covered |
| 97810 | CPT | Covered |
| 97814 | CPT | Covered |
| C1782 | HCPCS | Covered |
| C18.3 | ICD10CM | Covered |
| C20 | ICD10CM | Covered |
| C41.4 | ICD10CM | Covered |
| C51.0 | ICD10CM | Covered |
| C54.0 | ICD10CM | Covered |
| C54.9 | ICD10CM | Covered |
| C64.1 | ICD10CM | Covered |
| C64.9 | ICD10CM | Covered |
| C68.9 | ICD10CM | Covered |
| C69.20 | ICD10CM | Covered |
| C69.22 | ICD10CM | Covered |
| C76.3 | ICD10CM | Covered |
| D25.0 | ICD10CM | Covered |
| D25.9 | ICD10CM | Covered |
| D48.1 | ICD10CM | Covered |
| N30.0 | ICD10CM | Covered |
| N30.9 | ICD10CM | Covered |
| N39.0 | ICD10CM | Covered |
| N70.01 | ICD10CM | Covered |
| N73.9 | ICD10CM | Covered |
| N95.0 | ICD10CM | Covered |
| N95.9 | ICD10CM | Covered |
| N97.0 | ICD10CM | Covered |
| N97.9 | ICD10CM | Covered |
| Z78.0 | ICD10CM | Covered |
| Z79.890 | ICD10CM | Covered |
| Z84.81 | ICD10CM | Covered |
| Z85.3 | ICD10CM | Covered |
| Z85.40 | ICD10CM | Covered |
| Z85.44 | ICD10CM | Covered |
| Z92.3 | ICD10CM | Covered |