Aetna · PayerPolicy · AETNA-CPB-0517
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 |
|---|---|---|
| 77053 | CPT | Covered |
| 77054 | CPT | Covered |
| 88112 | CPT | Covered |
| 88161 | CPT | Covered |
| C50.011 | ICD10CM | Covered |
| C50.929 | ICD10CM | Covered |
| N61.0 | ICD10CM | Covered |
| N61.1 | ICD10CM | Covered |
| N63.0 | ICD10CM | Covered |
| N63.42 | ICD10CM | Covered |
| N64.3 | ICD10CM | Covered |
| N64.51 | ICD10CM | Covered |
| N64.52 | ICD10CM | Covered |
| N64.53 | ICD10CM | Covered |
| N64.9 | ICD10CM | Covered |
| T85. | ICD10CM | Covered |
| Z12.39 | ICD10CM | Covered |
| Z80.3 | ICD10CM | Covered |
| Z85.3 | ICD10CM | Covered |