Aetna · PayerPolicy · AETNA-CPB-0330
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 |
|---|---|---|
| 95782 | CPT | Covered |
| 95805 | CPT | Covered |
| 95806 | CPT | Covered |
| 95811 | CPT | Covered |
| F01.50 | ICD10CM | Covered |
| F02.80 | ICD10CM | Covered |
| F02.81 | ICD10CM | Covered |
| F03.90 | ICD10CM | Covered |
| F03.91 | ICD10CM | Covered |
| F10.27 | ICD10CM | Covered |
| F13.27 | ICD10CM | Covered |
| F13.97 | ICD10CM | Covered |
| F18.17 | ICD10CM | Covered |
| F18.27 | ICD10CM | Covered |
| F18.97 | ICD10CM | Covered |
| F19.17 | ICD10CM | Covered |
| F19.27 | ICD10CM | Covered |
| F19.97 | ICD10CM | Covered |
| F51.01 | ICD10CM | Covered |
| F51.03 | ICD10CM | Covered |
| F51.09 | ICD10CM | Covered |
| F51.13 | ICD10CM | Covered |
| F51.5 | ICD10CM | Covered |
| F90.0 | ICD10CM | Covered |
| F90.9 | ICD10CM | Covered |
| G20 | ICD10CM | Covered |
| G25.81 | ICD10CM | Covered |
| G30.0 | ICD10CM | Covered |
| G30.9 | ICD10CM | Covered |
| G31.09 | ICD10CM | Covered |
| G31.83 | ICD10CM | Covered |
| G47.00 | ICD10CM | Covered |
| G47.10 | ICD10CM | Covered |
| G47.19 | ICD10CM | Covered |
| G47.20 | ICD10CM | Covered |
| G47.29 | ICD10CM | Covered |
| G47.30 | ICD10CM | Covered |
| G47.33 | ICD10CM | Covered |
| G47.411 | ICD10CM | Covered |
| G47.429 | ICD10CM | Covered |
| G47.50 | ICD10CM | Covered |
| G47.53 | ICD10CM | Covered |
| G47.63 | ICD10CM | Covered |
| G47.9 | ICD10CM | Covered |
| R32 | ICD10CM | Covered |
| R44.0 | ICD10CM | Covered |
| R44.3 | ICD10CM | Covered |
| R53.81 | ICD10CM | Covered |
| R53.83 | ICD10CM | Covered |