Aetna · PayerPolicy · AETNA-CPB-0327
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 |
|---|---|---|
| 10005 | CPT | Covered |
| 10006 | CPT | Covered |
| 10021 | CPT | Covered |
| 43631 | CPT | Covered |
| 43635 | CPT | Covered |
| 43644 | CPT | Covered |
| 43645 | CPT | Covered |
| 43770 | CPT | Covered |
| 43775 | CPT | Covered |
| 43842 | CPT | Covered |
| 43848 | CPT | Covered |
| 43886 | CPT | Covered |
| 43888 | CPT | Covered |
| 81240 | CPT | Covered |
| 81241 | CPT | Covered |
| 81291 | CPT | Covered |
| 81370 | CPT | Covered |
| 81400 | CPT | Covered |
| 81406 | CPT | Covered |
| 83001 | CPT | Covered |
| 83090 | CPT | Covered |
| 85300 | CPT | Covered |
| 85306 | CPT | Covered |
| 86038 | CPT | Covered |
| 86039 | CPT | Covered |
| 86146 | CPT | Covered |
| 86148 | CPT | Covered |
| 86255 | CPT | Covered |
| 86357 | CPT | Covered |
| 88184 | CPT | Covered |
| 88185 | CPT | Covered |
| 88187 | CPT | Covered |
| 88189 | CPT | Covered |
| 89258 | CPT | Covered |
| 89259 | CPT | Covered |
| 89260 | CPT | Covered |
| 89261 | CPT | Covered |
| 89264 | CPT | Covered |
| 89268 | CPT | Covered |
| 89272 | CPT | Covered |
| 89280 | CPT | Covered |
| 89281 | CPT | Covered |
| 89290 | CPT | Covered |
| 89291 | CPT | Covered |
| 89300 | CPT | Covered |
| 89310 | CPT | Covered |
| 89320 | CPT | Covered |
| 89321 | CPT | Covered |
| 89322 | CPT | Covered |
| 89325 | CPT | Covered |
| 89329 | CPT | Covered |
| 89330 | CPT | Covered |
| 89331 | CPT | Covered |
| 89335 | CPT | Covered |
| 89337 | CPT | Covered |
| 89342 | CPT | Covered |
| 89346 | CPT | Covered |
| 89352 | CPT | Covered |
| 89353 | CPT | Covered |
| 89354 | CPT | Covered |
| 89356 | CPT | Covered |
| 90739 | CPT | Covered |
| 90747 | CPT | Covered |
| 90748 | CPT | Covered |
| 93975 | CPT | Covered |
| 93976 | CPT | Covered |
| 96040 | CPT | Covered |
| 97810 | CPT | Covered |
| 97814 | CPT | Covered |
| 99183 | CPT | Covered |
| A4575 | HCPCS | Covered |
| A9574 | HCPCS | Covered |
| B4185 | HCPCS | Covered |
| G0010 | HCPCS | Covered |
| G0027 | HCPCS | Covered |
| G0123 | HCPCS | Covered |
| G0124 | HCPCS | Covered |
| G0141 | HCPCS | Covered |
| G0148 | HCPCS | Covered |
| G0277 | HCPCS | Covered |
| G0472 | HCPCS | Covered |
| J0725 | HCPCS | Covered |
| J1561 | HCPCS | Covered |
| J1566 | HCPCS | Covered |
| J1568 | HCPCS | Covered |
| J1569 | HCPCS | Covered |
| J2940 | HCPCS | Covered |
| J2941 | HCPCS | Covered |
| J3355 | HCPCS | Covered |
| Q0515 | HCPCS | Covered |
| S0090 | HCPCS | Covered |
| S0132 | HCPCS | Covered |
| S4011 | HCPCS | Covered |
| S4035 | HCPCS | Covered |
| S4037 | HCPCS | Covered |
| S8930 | HCPCS | Covered |
| S9558 | HCPCS | Covered |
| A9574 | ICD10CM | Covered |
| B20 | ICD10CM | Covered |
| C00.0 | ICD10CM | Covered |
| C69.92 | ICD10CM | Covered |
| C81.00 | ICD10CM | Covered |
| C96.9 | ICD10CM | Covered |
| D25.0 | ICD10CM | Covered |
| D25.9 | ICD10CM | Covered |
| D27.0 | ICD10CM | Covered |
| D27.9 | ICD10CM | Covered |
| D29.30 | ICD10CM | Covered |
| D29.32 | ICD10CM | Covered |
| D35.2 | ICD10CM | Covered |
| D35.3 | ICD10CM | Covered |
| D39.0 | ICD10CM | Covered |
| D39.2 | ICD10CM | Covered |
| D40.8 | ICD10CM | Covered |
| D40.9 | ICD10CM | Covered |
| D44.3 | ICD10CM | Covered |
| D44.4 | ICD10CM | Covered |
| E01.8 | ICD10CM | Covered |
| E02 | ICD10CM | Covered |
| E03.0 | ICD10CM | Covered |
| E03.8 | ICD10CM | Covered |
| E22.1 | ICD10CM | Covered |
| E22.8 | ICD10CM | Covered |
| E22.9 | ICD10CM | Covered |
| E23.0 | ICD10CM | Covered |
| E23.6 | ICD10CM | Covered |
| E25.0 | ICD10CM | Covered |
| E25.9 | ICD10CM | Covered |
| E28.1 | ICD10CM | Covered |
| E28.2 | ICD10CM | Covered |
| E28.310 | ICD10CM | Covered |
| E28.319 | ICD10CM | Covered |
| E28.39 | ICD10CM | Covered |
| E29.1 | ICD10CM | Covered |
| E89.0 | ICD10CM | Covered |
| E89.40 | ICD10CM | Covered |
| E89.41 | ICD10CM | Covered |
| J1561 | ICD10CM | Covered |
| J1569 | ICD10CM | Covered |
| L68.0 | ICD10CM | Covered |
| N43.0 | ICD10CM | Covered |
| N43.42 | ICD10CM | Covered |
| N44.00 | ICD10CM | Covered |
| N44.8 | ICD10CM | Covered |
| N46.01 | ICD10CM | Covered |
| N46.9 | ICD10CM | Covered |
| N49.0 | ICD10CM | Covered |
| N49.9 | ICD10CM | Covered |
| N50.0 | ICD10CM | Covered |
| N50.9 | ICD10CM | Covered |
| N51 | ICD10CM | Covered |
| N52.0 | ICD10CM | Covered |
| N52.9 | ICD10CM | Covered |
| N53.11 | ICD10CM | Covered |
| N53.9 | ICD10CM | Covered |
| N64.3 | ICD10CM | Covered |
| N70.01 | ICD10CM | Covered |
| N70.93 | ICD10CM | Covered |
| N73.0 | ICD10CM | Covered |
| N73.9 | ICD10CM | Covered |
| N80. | ICD10CM | Covered |
| N80.0 | ICD10CM | Covered |
| N80.9 | ICD10CM | Covered |
| N83.00 | ICD10CM | Covered |
| N83.9 | ICD10CM | Covered |
| N84.0 | ICD10CM | Covered |
| N84.8 | ICD10CM | Covered |
| N85.6 | ICD10CM | Covered |
| N91.0 | ICD10CM | Covered |
| N91.2 | ICD10CM | Covered |
| N92.4 | ICD10CM | Covered |
| N92.5 | ICD10CM | Covered |
| N92.6 | ICD10CM | Covered |
| N94.2 | ICD10CM | Covered |
| N95.0 | ICD10CM | Covered |
| N95.9 | ICD10CM | Covered |
| N97.0 | ICD10CM | Covered |
| N97.9 | ICD10CM | Covered |
| N98.1 | ICD10CM | Covered |
| N99.83 | ICD10CM | Covered |
| Q50.01 | ICD10CM | Covered |
| Q50.6 | ICD10CM | Covered |
| Q51.0 | ICD10CM | Covered |
| Q51.20 | ICD10CM | Covered |
| Q51.28 | ICD10CM | Covered |
| Q51.5 | ICD10CM | Covered |
| Q51.7 | ICD10CM | Covered |
| Q51.820 | ICD10CM | Covered |
| Q51.9 | ICD10CM | Covered |
| Q52.0 | ICD10CM | Covered |
| Q52.9 | ICD10CM | Covered |
| Q53.00 | ICD10CM | Covered |
| Q53.9 | ICD10CM | Covered |
| Q55.0 | ICD10CM | Covered |
| Q55.21 | ICD10CM | Covered |
| Q55.29 | ICD10CM | Covered |
| Q55.4 | ICD10CM | Covered |
| Q55.7 | ICD10CM | Covered |
| Q55.8 | ICD10CM | Covered |
| Q96.9 | ICD10CM | Covered |
| Q98.0 | ICD10CM | Covered |
| Q98.4 | ICD10CM | Covered |
| R36.1 | ICD10CM | Covered |
| R39.83 | ICD10CM | Covered |
| R86.0 | ICD10CM | Covered |
| R86.9 | ICD10CM | Covered |
| R93.811 | ICD10CM | Covered |
| R93.9 | ICD10CM | Covered |
| T50.905 | ICD10CM | Covered |
| T66. | ICD10CM | Covered |
| Z11.3 | ICD10CM | Covered |
| Z14.01 | ICD10CM | Covered |
| Z14.02 | ICD10CM | Covered |
| Z14.1 | ICD10CM | Covered |
| Z14.8 | ICD10CM | Covered |
| Z20.828 | ICD10CM | Covered |
| Z21 | ICD10CM | Covered |
| Z23 | ICD10CM | Covered |
| Z31.0 | ICD10CM | Covered |
| Z31.41 | ICD10CM | Covered |
| Z31.89 | ICD10CM | Covered |
| Z52.810 | ICD10CM | Covered |
| Z52.819 | ICD10CM | Covered |
| Z78.0 | ICD10CM | Covered |
| Z79.890 | ICD10CM | Covered |
| Z90.710 | ICD10CM | Covered |
| Z90.712 | ICD10CM | Covered |
| Z90.721 | ICD10CM | Covered |
| Z90.722 | ICD10CM | Covered |
| Z90.79 | ICD10CM | Covered |
| Z98.51 | ICD10CM | Covered |
| Z98.52 | ICD10CM | Covered |