Aetna · PayerPolicy · AETNA-CPB-0363
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 |
|---|---|---|
| 00001 | CPT | Covered |
| 97037 | CPT | Covered |
| S8948 | HCPCS | Covered |
| B00.9 | ICD10CM | Covered |
| C18.0 | ICD10CM | Covered |
| C21.8 | ICD10CM | Covered |
| E06.3 | ICD10CM | Covered |
| E66.01 | ICD10CM | Covered |
| E66.9 | ICD10CM | Covered |
| E75.00 | ICD10CM | Covered |
| E75.6 | ICD10CM | Covered |
| F01.50 | ICD10CM | Covered |
| F01.518 | ICD10CM | Covered |
| F02.80 | ICD10CM | Covered |
| F02.818 | ICD10CM | Covered |
| F03.90 | ICD10CM | Covered |
| F03.918 | ICD10CM | Covered |
| F32.0 | ICD10CM | Covered |
| F33.9 | ICD10CM | Covered |
| G10 | ICD10CM | Covered |
| G37.9 | ICD10CM | Covered |
| G50.0 | ICD10CM | Covered |
| G56.00 | ICD10CM | Covered |
| G56.03 | ICD10CM | Covered |
| G90.01 | ICD10CM | Covered |
| G94 | ICD10CM | Covered |
| H93. | ICD10CM | Covered |
| H93.11 | ICD10CM | Covered |
| H93.19 | ICD10CM | Covered |
| K04.4 | ICD10CM | Covered |
| K04.5 | ICD10CM | Covered |
| K05.20 | ICD10CM | Covered |
| K05.229 | ICD10CM | Covered |
| K05.30 | ICD10CM | Covered |
| K05.329 | ICD10CM | Covered |
| K08.0 | ICD10CM | Covered |
| K12.0 | ICD10CM | Covered |
| K12.30 | ICD10CM | Covered |
| K12.39 | ICD10CM | Covered |
| K14.6 | ICD10CM | Covered |
| L10.0 | ICD10CM | Covered |
| L43.0 | ICD10CM | Covered |
| L43.9 | ICD10CM | Covered |
| L63.0 | ICD10CM | Covered |
| L63.9 | ICD10CM | Covered |
| L64.0 | ICD10CM | Covered |
| L64.9 | ICD10CM | Covered |
| L65.0 | ICD10CM | Covered |
| L65.9 | ICD10CM | Covered |
| L89 | ICD10CM | Covered |
| L89.95 | ICD10CM | Covered |
| M00.00 | ICD10CM | Covered |
| M99.9 | ICD10CM | Covered |
| N64.4 | ICD10CM | Covered |
| Q35.1 | ICD10CM | Covered |
| Q37.9 | ICD10CM | Covered |
| S04. | ICD10CM | Covered |
| S06. | ICD10CM | Covered |
| S39.001A | ICD10CM | Covered |
| S39.093S | ICD10CM | Covered |
| S46.001A | ICD10CM | Covered |
| S46.999S | ICD10CM | Covered |
| S56.001A | ICD10CM | Covered |
| S56.999S | ICD10CM | Covered |
| S66.001A | ICD10CM | Covered |
| S66.999S | ICD10CM | Covered |
| S76.001A | ICD10CM | Covered |
| S76.999S | ICD10CM | Covered |
| S86.001A | ICD10CM | Covered |
| S86.999S | ICD10CM | Covered |
| S96.001S | ICD10CM | Covered |
| S96.999S | ICD10CM | Covered |
| T20.00A | ICD10CM | Covered |
| T20.39S | ICD10CM | Covered |
| T21.00A | ICD10CM | Covered |
| T21.39S | ICD10CM | Covered |
| T22.00A | ICD10CM | Covered |
| T22.399S | ICD10CM | Covered |
| T23.00A | ICD10CM | Covered |
| T23.399S | ICD10CM | Covered |
| T24.00A | ICD10CM | Covered |
| T24.399S | ICD10CM | Covered |
| T25.00A | ICD10CM | Covered |
| T25.399S | ICD10CM | Covered |
| T26.00A | ICD10CM | Covered |
| T26.399S | ICD10CM | Covered |
| T31.00A | ICD10CM | Covered |
| T31.99S | ICD10CM | Covered |
| T81. | ICD10CM | Covered |
| T85.44A | ICD10CM | Covered |
| T85.44S | ICD10CM | Covered |
| Z98.890 | ICD10CM | Covered |