Aetna · PayerPolicy · AETNA-CPB-0475
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 |
|---|---|---|
| 29800 | CPT | Covered |
| 29999 | CPT | Covered |
| 30465 | CPT | Covered |
| 30469 | CPT | Covered |
| 30801 | CPT | Covered |
| 30802 | CPT | Covered |
| 31254 | CPT | Covered |
| 31288 | CPT | Covered |
| 31400 | CPT | Covered |
| 31560 | CPT | Covered |
| 31561 | CPT | Covered |
| 42820 | CPT | Covered |
| 42826 | CPT | Covered |
| 64633 | CPT | Covered |
| 64634 | CPT | Covered |
| B02.22 | ICD10CM | Covered |
| B48.1 | ICD10CM | Covered |
| C10.0 | ICD10CM | Covered |
| C10.9 | ICD10CM | Covered |
| C32.0 | ICD10CM | Covered |
| C32.9 | ICD10CM | Covered |
| C33 | ICD10CM | Covered |
| D10.6 | ICD10CM | Covered |
| D14.1 | ICD10CM | Covered |
| D14.2 | ICD10CM | Covered |
| D16.6 | ICD10CM | Covered |
| D37.05 | ICD10CM | Covered |
| G44.81 | ICD10CM | Covered |
| G44.84 | ICD10CM | Covered |
| G50.0 | ICD10CM | Covered |
| G54.6 | ICD10CM | Covered |
| H61.301 | ICD10CM | Covered |
| H61.399 | ICD10CM | Covered |
| J03.00 | ICD10CM | Covered |
| J03.91 | ICD10CM | Covered |
| J34.3 | ICD10CM | Covered |
| J34.89 | ICD10CM | Covered |
| J35.01 | ICD10CM | Covered |
| J35.1 | ICD10CM | Covered |
| J36 | ICD10CM | Covered |
| J38.00 | ICD10CM | Covered |
| J38.02 | ICD10CM | Covered |
| J38.7 | ICD10CM | Covered |
| J39.8 | ICD10CM | Covered |
| L89.000 | ICD10CM | Covered |
| L89.95 | ICD10CM | Covered |
| M00.00 | ICD10CM | Covered |
| M99.9 | ICD10CM | Covered |
| Q16.1 | ICD10CM | Covered |
| R13.10 | ICD10CM | Covered |
| R13.19 | ICD10CM | Covered |
| R42 | ICD10CM | Covered |
| T20. | ICD10CM | Covered |
| T32.99 | ICD10CM | Covered |
| T87.9 | ICD10CM | Covered |