Aetna · PayerPolicy · AETNA-CPB-0492
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 |
|---|---|---|
| 10004 | CPT | Covered |
| 10021 | CPT | Covered |
| C15.3 | ICD10CM | Covered |
| C15.9 | ICD10CM | Covered |
| C16.0 | ICD10CM | Covered |
| C18.9 | ICD10CM | Covered |
| C22.0 | ICD10CM | Covered |
| C23 | ICD10CM | Covered |
| C24.9 | ICD10CM | Covered |
| C25.0 | ICD10CM | Covered |
| C25.9 | ICD10CM | Covered |
| C34.00 | ICD10CM | Covered |
| C34.92 | ICD10CM | Covered |
| C37 | ICD10CM | Covered |
| C41.0 | ICD10CM | Covered |
| C41.9 | ICD10CM | Covered |
| C49.0 | ICD10CM | Covered |
| C49.9 | ICD10CM | Covered |
| C50.011 | ICD10CM | Covered |
| C50.929 | ICD10CM | Covered |
| C64.1 | ICD10CM | Covered |
| C64.9 | ICD10CM | Covered |
| C65.1 | ICD10CM | Covered |
| C65.9 | ICD10CM | Covered |
| C73 | ICD10CM | Covered |
| C74.00 | ICD10CM | Covered |
| C74.92 | ICD10CM | Covered |
| C78.00 | ICD10CM | Covered |
| C78.02 | ICD10CM | Covered |
| C79.49 | ICD10CM | Covered |
| C79.70 | ICD10CM | Covered |
| C79.72 | ICD10CM | Covered |
| D02.20 | ICD10CM | Covered |
| D02.22 | ICD10CM | Covered |
| D13.2 | ICD10CM | Covered |
| D16.00 | ICD10CM | Covered |
| D16.9 | ICD10CM | Covered |
| D30.00 | ICD10CM | Covered |
| D30.12 | ICD10CM | Covered |
| D34 | ICD10CM | Covered |
| D37.01 | ICD10CM | Covered |
| D37.08 | ICD10CM | Covered |
| D48.1 | ICD10CM | Covered |
| D48.3 | ICD10CM | Covered |
| D48.7 | ICD10CM | Covered |
| D49.2 | ICD10CM | Covered |
| E04.0 | ICD10CM | Covered |
| E04.9 | ICD10CM | Covered |
| E05.10 | ICD10CM | Covered |
| E05.11 | ICD10CM | Covered |
| E05.2 | ICD10CM | Covered |
| E05.21 | ICD10CM | Covered |
| G89.3 | ICD10CM | Covered |
| K83.1 | ICD10CM | Covered |
| N18.3 | ICD10CM | Covered |
| N18.4 | ICD10CM | Covered |
| N18.5 | ICD10CM | Covered |
| N28.1 | ICD10CM | Covered |
| N28.84 | ICD10CM | Covered |
| Q60.0 | ICD10CM | Covered |
| Q61.00 | ICD10CM | Covered |
| Q61.9 | ICD10CM | Covered |
| T86.19 | ICD10CM | Covered |
| Z90.5 | ICD10CM | Covered |