Aetna · PayerPolicy · AETNA-CPB-0532
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 |
|---|---|---|
| 76870 | CPT | Covered |
| C63.2 | ICD10CM | Covered |
| D29.4 | ICD10CM | Covered |
| D40.10 | ICD10CM | Covered |
| D40.12 | ICD10CM | Covered |
| N43.0 | ICD10CM | Covered |
| N43.42 | ICD10CM | Covered |
| N44.00 | ICD10CM | Covered |
| N44.04 | ICD10CM | Covered |
| N45.1 | ICD10CM | Covered |
| N45.4 | ICD10CM | Covered |
| N46.01 | ICD10CM | Covered |
| N46.9 | ICD10CM | Covered |
| N50.0 | ICD10CM | Covered |
| N50.811 | ICD10CM | Covered |
| N50.819 | ICD10CM | Covered |
| N50.82 | ICD10CM | Covered |
| P83.5 | ICD10CM | Covered |
| Q53.00 | ICD10CM | Covered |
| Q53.9 | ICD10CM | Covered |
| Q55.22 | ICD10CM | Covered |
| Q55.23 | ICD10CM | Covered |
| R39.83 | ICD10CM | Covered |
| R39.84 | ICD10CM | Covered |
| S39.848 | ICD10CM | Covered |
| S39.94X | ICD10CM | Covered |