Aetna · PayerPolicy · AETNA-CPB-0310
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 |
|---|---|---|
| 32664 | CPT | Covered |
| G56.40 | ICD10CM | Covered |
| G56.42 | ICD10CM | Covered |
| G57.70 | ICD10CM | Covered |
| G57.72 | ICD10CM | Covered |
| L70.0 | ICD10CM | Covered |
| L74.510 | ICD10CM | Covered |
| L74.511 | ICD10CM | Covered |
| L74.512 | ICD10CM | Covered |
| L74.513 | ICD10CM | Covered |
| L74.519 | ICD10CM | Covered |
| L74.52 | ICD10CM | Covered |
| R23.2 | ICD10CM | Covered |