Aetna · PayerPolicy · AETNA-CPB-0353
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 |
|---|---|---|
| B50.0 | ICD10CM | Covered |
| C71.0 | ICD10CM | Covered |
| C71.9 | ICD10CM | Covered |
| C79.31 | ICD10CM | Covered |
| C79.49 | ICD10CM | Covered |
| D33.0 | ICD10CM | Covered |
| D33.2 | ICD10CM | Covered |
| D43.0 | ICD10CM | Covered |
| D43.4 | ICD10CM | Covered |
| D49.6 | ICD10CM | Covered |
| E75.00 | ICD10CM | Covered |
| E75.19 | ICD10CM | Covered |
| E75.23 | ICD10CM | Covered |
| E75.25 | ICD10CM | Covered |
| E75.29 | ICD10CM | Covered |
| E75.4 | ICD10CM | Covered |
| F01.50 | ICD10CM | Covered |
| F84.2 | ICD10CM | Covered |
| F99 | ICD10CM | Covered |
| G00.0 | ICD10CM | Covered |
| G09 | ICD10CM | Covered |
| G10 | ICD10CM | Covered |
| G12.9 | ICD10CM | Covered |
| G13.8 | ICD10CM | Covered |
| G20 | ICD10CM | Covered |
| G26 | ICD10CM | Covered |
| G30.0 | ICD10CM | Covered |
| G32.8 | ICD10CM | Covered |
| G40.00 | ICD10CM | Covered |
| G40.919 | ICD10CM | Covered |
| G43.001 | ICD10CM | Covered |
| G43.919 | ICD10CM | Covered |
| G80.3 | ICD10CM | Covered |
| G90.01 | ICD10CM | Covered |
| G91.9 | ICD10CM | Covered |
| G93.7 | ICD10CM | Covered |
| G93.89 | ICD10CM | Covered |
| G93.9 | ICD10CM | Covered |
| G94 | ICD10CM | Covered |
| G95.0 | ICD10CM | Covered |
| G95.9 | ICD10CM | Covered |
| G99.0 | ICD10CM | Covered |
| G99.8 | ICD10CM | Covered |
| Q85.00 | ICD10CM | Covered |
| Q85.9 | ICD10CM | Covered |
| R56.1 | ICD10CM | Covered |
| R56.9 | ICD10CM | Covered |
| S02. | ICD10CM | Covered |
| S02.600A | ICD10CM | Covered |
| S04.011A | ICD10CM | Covered |
| S04.899S | ICD10CM | Covered |
| S06. | ICD10CM | Covered |
| Z13.6 | ICD10CM | Covered |
| Z79.01 | ICD10CM | Covered |
| Z79.02 | ICD10CM | Covered |
| Z95.811 | ICD10CM | Covered |