Aetna · PayerPolicy · AETNA-CPB-0352
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 |
|---|---|---|
| 81120 | CPT | Covered |
| 81121 | CPT | Covered |
| 81168 | CPT | Covered |
| 81194 | CPT | Covered |
| 81210 | CPT | Covered |
| 81218 | CPT | Covered |
| 81219 | CPT | Covered |
| 81233 | CPT | Covered |
| 81235 | CPT | Covered |
| 81236 | CPT | Covered |
| 81237 | CPT | Covered |
| 81270 | CPT | Covered |
| 81272 | CPT | Covered |
| 81273 | CPT | Covered |
| 81275 | CPT | Covered |
| 81276 | CPT | Covered |
| 81288 | CPT | Covered |
| 81292 | CPT | Covered |
| 81301 | CPT | Covered |
| 81305 | CPT | Covered |
| 81309 | CPT | Covered |
| 81314 | CPT | Covered |
| 81315 | CPT | Covered |
| 81316 | CPT | Covered |
| 81320 | CPT | Covered |
| 81334 | CPT | Covered |
| 81338 | CPT | Covered |
| 81339 | CPT | Covered |
| 81340 | CPT | Covered |
| 81342 | CPT | Covered |
| 81345 | CPT | Covered |
| 81347 | CPT | Covered |
| 81348 | CPT | Covered |
| 81351 | CPT | Covered |
| 81352 | CPT | Covered |
| 81357 | CPT | Covered |
| 81401 | CPT | Covered |
| 81406 | CPT | Covered |
| 81445 | CPT | Covered |
| 81449 | CPT | Covered |
| 81450 | CPT | Covered |
| 81451 | CPT | Covered |
| 81455 | CPT | Covered |
| 81456 | CPT | Covered |
| 81457 | CPT | Covered |
| 81462 | CPT | Covered |
| 81464 | CPT | Covered |
| 81500 | CPT | Covered |
| 81503 | CPT | Covered |
| 81504 | CPT | Covered |
| 81518 | CPT | Covered |
| 81519 | CPT | Covered |
| 81520 | CPT | Covered |
| 81521 | CPT | Covered |
| 81522 | CPT | Covered |
| 81523 | CPT | Covered |
| 81525 | CPT | Covered |
| 81529 | CPT | Covered |
| 81538 | CPT | Covered |
| 81539 | CPT | Covered |
| 81540 | CPT | Covered |
| 81541 | CPT | Covered |
| 81542 | CPT | Covered |
| 81551 | CPT | Covered |
| 81552 | CPT | Covered |
| 82107 | CPT | Covered |
| 82232 | CPT | Covered |
| 82308 | CPT | Covered |
| 82387 | CPT | Covered |
| 82777 | CPT | Covered |
| 83497 | CPT | Covered |
| 83615 | CPT | Covered |
| 83951 | CPT | Covered |
| 84080 | CPT | Covered |
| 84233 | CPT | Covered |
| 84234 | CPT | Covered |
| 84275 | CPT | Covered |
| 84432 | CPT | Covered |
| 84704 | CPT | Covered |
| 85415 | CPT | Covered |
| 86152 | CPT | Covered |
| 86153 | CPT | Covered |
| 86304 | CPT | Covered |
| 86305 | CPT | Covered |
| 86316 | CPT | Covered |
| 86336 | CPT | Covered |
| 86800 | CPT | Covered |
| 87624 | CPT | Covered |
| 88184 | CPT | Covered |
| 88185 | CPT | Covered |
| 88313 | CPT | Covered |
| 88341 | CPT | Covered |
| 88342 | CPT | Covered |
| 88344 | CPT | Covered |
| 88360 | CPT | Covered |
| 88361 | CPT | Covered |
| 88363 | CPT | Covered |
| S3854 | HCPCS | Covered |
| B17.10 | ICD10CM | Covered |
| B17.11 | ICD10CM | Covered |
| B18.2 | ICD10CM | Covered |
| B19.20 | ICD10CM | Covered |
| B19.21 | ICD10CM | Covered |
| C00.0 | ICD10CM | Covered |
| C11.0 | ICD10CM | Covered |
| C14.8 | ICD10CM | Covered |
| C15.3 | ICD10CM | Covered |
| C15.9 | ICD10CM | Covered |
| C16.0 | ICD10CM | Covered |
| C16.9 | ICD10CM | Covered |
| C17.0 | ICD10CM | Covered |
| C17.9 | ICD10CM | Covered |
| C18.0 | ICD10CM | Covered |
| C18.9 | ICD10CM | Covered |
| C19 | ICD10CM | Covered |
| C20 | ICD10CM | Covered |
| C21.8 | ICD10CM | Covered |
| C22.0 | ICD10CM | Covered |
| C22.1 | ICD10CM | Covered |
| C22.2 | ICD10CM | Covered |
| C22.9 | ICD10CM | Covered |
| C23 | ICD10CM | Covered |
| C24.0 | ICD10CM | Covered |
| C24.9 | ICD10CM | Covered |
| C25.0 | ICD10CM | Covered |
| C25.9 | ICD10CM | Covered |
| C34.00 | ICD10CM | Covered |
| C34.92 | ICD10CM | Covered |
| C37 | ICD10CM | Covered |
| C40.00 | ICD10CM | Covered |
| C41.0 | ICD10CM | Covered |
| C41.9 | ICD10CM | Covered |
| C43 | ICD10CM | Covered |
| C43.0 | ICD10CM | Covered |
| C43.9 | ICD10CM | Covered |
| C44.00 | ICD10CM | Covered |
| C44.02 | ICD10CM | Covered |
| C44.121 | ICD10CM | Covered |
| C44.129 | ICD10CM | Covered |
| C44.221 | ICD10CM | Covered |
| C44.229 | ICD10CM | Covered |
| C44.320 | ICD10CM | Covered |
| C44.329 | ICD10CM | Covered |
| C44.42 | ICD10CM | Covered |
| C44.99 | ICD10CM | Covered |
| C45.0 | ICD10CM | Covered |
| C45.1 | ICD10CM | Covered |
| C48.2 | ICD10CM | Covered |
| C49.0 | ICD10CM | Covered |
| C49.4 | ICD10CM | Covered |
| C49.9 | ICD10CM | Covered |
| C50 | ICD10CM | Covered |
| C50.011 | ICD10CM | Covered |
| C50.019 | ICD10CM | Covered |
| C50.021 | ICD10CM | Covered |
| C50.029 | ICD10CM | Covered |
| C50.111 | ICD10CM | Covered |
| C50.119 | ICD10CM | Covered |
| C50.121 | ICD10CM | Covered |
| C50.129 | ICD10CM | Covered |
| C50.211 | ICD10CM | Covered |
| C50.219 | ICD10CM | Covered |
| C50.221 | ICD10CM | Covered |
| C50.229 | ICD10CM | Covered |
| C50.311 | ICD10CM | Covered |
| C50.319 | ICD10CM | Covered |
| C50.321 | ICD10CM | Covered |
| C50.329 | ICD10CM | Covered |
| C50.411 | ICD10CM | Covered |
| C50.419 | ICD10CM | Covered |
| C50.421 | ICD10CM | Covered |
| C50.429 | ICD10CM | Covered |
| C50.511 | ICD10CM | Covered |
| C50.519 | ICD10CM | Covered |
| C50.521 | ICD10CM | Covered |
| C50.529 | ICD10CM | Covered |
| C50.611 | ICD10CM | Covered |
| C50.619 | ICD10CM | Covered |
| C50.621 | ICD10CM | Covered |
| C50.629 | ICD10CM | Covered |
| C50.811 | ICD10CM | Covered |
| C50.819 | ICD10CM | Covered |
| C50.821 | ICD10CM | Covered |
| C50.829 | ICD10CM | Covered |
| C50.911 | ICD10CM | Covered |
| C50.919 | ICD10CM | Covered |
| C50.921 | ICD10CM | Covered |
| C50.929 | ICD10CM | Covered |
| C53 | ICD10CM | Covered |
| C53.0 | ICD10CM | Covered |
| C53.9 | ICD10CM | Covered |
| C54 | ICD10CM | Covered |
| C54.0 | ICD10CM | Covered |
| C54.1 | ICD10CM | Covered |
| C54.9 | ICD10CM | Covered |
| C55 | ICD10CM | Covered |
| C56.1 | ICD10CM | Covered |
| C56.9 | ICD10CM | Covered |
| C58 | ICD10CM | Covered |
| C60 | ICD10CM | Covered |
| C61 | ICD10CM | Covered |
| C62 | ICD10CM | Covered |
| C62.00 | ICD10CM | Covered |
| C62.92 | ICD10CM | Covered |
| C64.1 | ICD10CM | Covered |
| C64.10 | ICD10CM | Covered |
| C64.9 | ICD10CM | Covered |
| C65.9 | ICD10CM | Covered |
| C66.9 | ICD10CM | Covered |
| C67.0 | ICD10CM | Covered |
| C67.9 | ICD10CM | Covered |
| C69.30 | ICD10CM | Covered |
| C69.32 | ICD10CM | Covered |
| C69.40 | ICD10CM | Covered |
| C69.42 | ICD10CM | Covered |
| C71.0 | ICD10CM | Covered |
| C71.9 | ICD10CM | Covered |
| C73 | ICD10CM | Covered |
| C76 | ICD10CM | Covered |
| C76.0 | ICD10CM | Covered |
| C77.1 | ICD10CM | Covered |
| C77.3 | ICD10CM | Covered |
| C80.0 | ICD10CM | Covered |
| C80.1 | ICD10CM | Covered |
| C80.2 | ICD10CM | Covered |
| C81.00 | ICD10CM | Covered |
| C82.00 | ICD10CM | Covered |
| C82.99 | ICD10CM | Covered |
| C83.00 | ICD10CM | Covered |
| C83.09 | ICD10CM | Covered |
| C83.10 | ICD10CM | Covered |
| C83.19 | ICD10CM | Covered |
| C83.30 | ICD10CM | Covered |
| C83.39 | ICD10CM | Covered |
| C83.50 | ICD10CM | Covered |
| C83.59 | ICD10CM | Covered |
| C83.89 | ICD10CM | Covered |
| C84. | ICD10CM | Covered |
| C84.00 | ICD10CM | Covered |
| C84.09 | ICD10CM | Covered |
| C84.10 | ICD10CM | Covered |
| C84.19 | ICD10CM | Covered |
| C84.40 | ICD10CM | Covered |
| C84.49 | ICD10CM | Covered |
| C84.99 | ICD10CM | Covered |
| C85.10 | ICD10CM | Covered |
| C85.99 | ICD10CM | Covered |
| C86.0 | ICD10CM | Covered |
| C86.1 | ICD10CM | Covered |
| C86.4 | ICD10CM | Covered |
| C86.6 | ICD10CM | Covered |
| C88.0 | ICD10CM | Covered |
| C88.4 | ICD10CM | Covered |
| C90.00 | ICD10CM | Covered |
| C90.02 | ICD10CM | Covered |
| C91 | ICD10CM | Covered |
| C91.00 | ICD10CM | Covered |
| C91.02 | ICD10CM | Covered |
| C91.10 | ICD10CM | Covered |
| C91.12 | ICD10CM | Covered |
| C91.40 | ICD10CM | Covered |
| C91.42 | ICD10CM | Covered |
| C91.60 | ICD10CM | Covered |
| C91.62 | ICD10CM | Covered |
| C92 | ICD10CM | Covered |
| C92. | ICD10CM | Covered |
| C92.00 | ICD10CM | Covered |
| C92.02 | ICD10CM | Covered |
| C92.10 | ICD10CM | Covered |
| C92.12 | ICD10CM | Covered |
| C92.20 | ICD10CM | Covered |
| C92.22 | ICD10CM | Covered |
| C92.40 | ICD10CM | Covered |
| C93.00 | ICD10CM | Covered |
| C93.02 | ICD10CM | Covered |
| C94 | ICD10CM | Covered |
| C94.00 | ICD10CM | Covered |
| C94.02 | ICD10CM | Covered |
| C94.40 | ICD10CM | Covered |
| C94.42 | ICD10CM | Covered |
| C94.6 | ICD10CM | Covered |
| C95.00 | ICD10CM | Covered |
| C95.02 | ICD10CM | Covered |
| C96. | ICD10CM | Covered |
| C96.0 | ICD10CM | Covered |
| C96.4 | ICD10CM | Covered |
| C96.9 | ICD10CM | Covered |
| D01.0 | ICD10CM | Covered |
| D01.1 | ICD10CM | Covered |
| D01.2 | ICD10CM | Covered |
| D01.5 | ICD10CM | Covered |
| D02.20 | ICD10CM | Covered |
| D02.22 | ICD10CM | Covered |
| D05.00 | ICD10CM | Covered |
| D05.92 | ICD10CM | Covered |
| D07.30 | ICD10CM | Covered |
| D07.39 | ICD10CM | Covered |
| D07.5 | ICD10CM | Covered |
| D07.60 | ICD10CM | Covered |
| D07.69 | ICD10CM | Covered |
| D09.0 | ICD10CM | Covered |
| D09.10 | ICD10CM | Covered |
| D09.19 | ICD10CM | Covered |
| D09.3 | ICD10CM | Covered |
| D12.0 | ICD10CM | Covered |
| D12.7 | ICD10CM | Covered |
| D12.9 | ICD10CM | Covered |
| D14.30 | ICD10CM | Covered |
| D14.32 | ICD10CM | Covered |
| D15.0 | ICD10CM | Covered |
| D27.0 | ICD10CM | Covered |
| D27.9 | ICD10CM | Covered |
| D29.20 | ICD10CM | Covered |
| D29.22 | ICD10CM | Covered |
| D30.00 | ICD10CM | Covered |
| D30.12 | ICD10CM | Covered |
| D34 | ICD10CM | Covered |
| D39.10 | ICD10CM | Covered |
| D39.12 | ICD10CM | Covered |
| D39.2 | ICD10CM | Covered |
| D44.0 | ICD10CM | Covered |
| D45 | ICD10CM | Covered |
| D46 | ICD10CM | Covered |
| D46.0 | ICD10CM | Covered |
| D46.20 | ICD10CM | Covered |
| D46.9 | ICD10CM | Covered |
| D46.Z | ICD10CM | Covered |
| D47 | ICD10CM | Covered |
| D47. | ICD10CM | Covered |
| D47.02 | ICD10CM | Covered |
| D47.1 | ICD10CM | Covered |
| D47.3 | ICD10CM | Covered |
| D47.4 | ICD10CM | Covered |
| D48.5 | ICD10CM | Covered |
| D69.3 | ICD10CM | Covered |
| D75.81 | ICD10CM | Covered |
| D816V | ICD10CM | Covered |
| E04. | ICD10CM | Covered |
| E04.0 | ICD10CM | Covered |
| E04.9 | ICD10CM | Covered |
| E83.110 | ICD10CM | Covered |
| E88.01 | ICD10CM | Covered |
| F10.10 | ICD10CM | Covered |
| F10.99 | ICD10CM | Covered |
| K70.30 | ICD10CM | Covered |
| K70.31 | ICD10CM | Covered |
| K74.3 | ICD10CM | Covered |
| K74.60 | ICD10CM | Covered |
| K74.69 | ICD10CM | Covered |
| K75.81 | ICD10CM | Covered |
| N28.89 | ICD10CM | Covered |
| N50.8 | ICD10CM | Covered |
| N62 | ICD10CM | Covered |
| P53 | ICD10CM | Covered |
| R19.00 | ICD10CM | Covered |
| R19.07 | ICD10CM | Covered |
| R19.09 | ICD10CM | Covered |
| R31.0 | ICD10CM | Covered |
| R31.9 | ICD10CM | Covered |
| R91.8 | ICD10CM | Covered |
| T790M | ICD10CM | Covered |
| V600 | ICD10CM | Covered |
| V600E | ICD10CM | Covered |
| V617F | ICD10CM | Covered |
| Z12.6 | ICD10CM | Covered |
| Z12.73 | ICD10CM | Covered |
| Z12.89 | ICD10CM | Covered |
| Z17.0 | ICD10CM | Covered |
| Z17.1 | ICD10CM | Covered |
| Z22.51 | ICD10CM | Covered |
| Z80.0 | ICD10CM | Covered |
| Z85.43 | ICD10CM | Covered |
| Z85.47 | ICD10CM | Covered |
| Z85.51 | ICD10CM | Covered |