Aetna · PayerPolicy · AETNA-CPB-0362
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 |
|---|---|---|
| 27325 | CPT | Covered |
| 27326 | CPT | Covered |
| 28055 | CPT | Covered |
| 61863 | CPT | Covered |
| 61864 | CPT | Covered |
| 61867 | CPT | Covered |
| 61868 | CPT | Covered |
| 61880 | CPT | Covered |
| 61885 | CPT | Covered |
| 61886 | CPT | Covered |
| 61888 | CPT | Covered |
| 63170 | CPT | Covered |
| 63185 | CPT | Covered |
| 63190 | CPT | Covered |
| 63600 | CPT | Covered |
| 63650 | CPT | Covered |
| 63655 | CPT | Covered |
| 63661 | CPT | Covered |
| 63664 | CPT | Covered |
| 63685 | CPT | Covered |
| 63688 | CPT | Covered |
| 64600 | CPT | Covered |
| 64640 | CPT | Covered |
| 64642 | CPT | Covered |
| 64645 | CPT | Covered |
| 64708 | CPT | Covered |
| 64714 | CPT | Covered |
| 90867 | CPT | Covered |
| 90869 | CPT | Covered |
| 97014 | CPT | Covered |
| 97032 | CPT | Covered |
| 97810 | CPT | Covered |
| 97814 | CPT | Covered |
| A4556 | HCPCS | Covered |
| A4557 | HCPCS | Covered |
| A4558 | HCPCS | Covered |
| A4595 | HCPCS | Covered |
| C1767 | HCPCS | Covered |
| C1778 | HCPCS | Covered |
| C1787 | HCPCS | Covered |
| C1816 | HCPCS | Covered |
| C1820 | HCPCS | Covered |
| C1883 | HCPCS | Covered |
| E0720 | HCPCS | Covered |
| E0730 | HCPCS | Covered |
| E0731 | HCPCS | Covered |
| E0745 | HCPCS | Covered |
| E0762 | HCPCS | Covered |
| E0764 | HCPCS | Covered |
| E0770 | HCPCS | Covered |
| G0295 | HCPCS | Covered |
| J0475 | HCPCS | Covered |
| J0476 | HCPCS | Covered |
| J0585 | HCPCS | Covered |
| J0588 | HCPCS | Covered |
| L8679 | HCPCS | Covered |
| L8695 | HCPCS | Covered |
| S3900 | HCPCS | Covered |
| E75.21 | ICD10CM | Covered |
| E75.29 | ICD10CM | Covered |
| G20 | ICD10CM | Covered |
| G26 | ICD10CM | Covered |
| G30.0 | ICD10CM | Covered |
| G32.8 | ICD10CM | Covered |
| G35 | ICD10CM | Covered |
| G45.0 | ICD10CM | Covered |
| G45.9 | ICD10CM | Covered |
| G81.10 | ICD10CM | Covered |
| G81.14 | ICD10CM | Covered |
| M21.171 | ICD10CM | Covered |
| M21.179 | ICD10CM | Covered |
| M21.541 | ICD10CM | Covered |
| M21.549 | ICD10CM | Covered |
| M24.50 | ICD10CM | Covered |
| M24.576 | ICD10CM | Covered |
| M41.00 | ICD10CM | Covered |
| M41.9 | ICD10CM | Covered |
| M62.40 | ICD10CM | Covered |
| M62.421 | ICD10CM | Covered |
| M62.429 | ICD10CM | Covered |
| M62.49 | ICD10CM | Covered |
| M62.81 | ICD10CM | Covered |
| M62.830 | ICD10CM | Covered |
| M62.838 | ICD10CM | Covered |
| Q66.0 | ICD10CM | Covered |
| R25.0 | ICD10CM | Covered |
| R25.2 | ICD10CM | Covered |
| R25.9 | ICD10CM | Covered |
| S12 | ICD10CM | Covered |
| S14 | ICD10CM | Covered |
| S22 | ICD10CM | Covered |
| S24 | ICD10CM | Covered |
| S32 | ICD10CM | Covered |
| S34 | ICD10CM | Covered |