Magnesium Sulfate Injections and Terbutaline Pump f… | Aetna

Magnesium Sulfate Injections and Terbutaline Pump for Preterm Labor

Aetna · PayerPolicy · AETNA-CPB-0468

Status: Active
Effective: June 15, 2023
Last reviewed by Aetna: July 17, 2026
Last checked by Backwork: August 1, 2026

Summary of the payer’s published policy. Not a coverage determination — confirm with Aetna before submitting.

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Codes in this policy

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.

Codes this policy lists and each code’s status in the policy
Code	Code system	Status in this policy
99601	CPT	Covered
99602	CPT	Covered
E0779	HCPCS	Covered
E0780	HCPCS	Covered
E0781	HCPCS	Covered
J3105	HCPCS	Covered
J3475	HCPCS	Covered
S9208	HCPCS	Covered
S9349	HCPCS	Covered
E0781	ICD10CM	Covered