Vesicoureteral Reflux Treatment by Endoscopic Injec… | Aetna

Vesicoureteral Reflux Treatment by Endoscopic Injection of Bulking Agents

Aetna · PayerPolicy · AETNA-CPB-0534

Status: Active
Effective: August 8, 2023
Last reviewed by Aetna: July 30, 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
51715	CPT	Covered
52327	CPT	Covered
74420	CPT	Covered
74450	CPT	Covered
74455	CPT	Covered
78740	CPT	Covered
L8603	HCPCS	Covered
L8604	HCPCS	Covered
L8606	HCPCS	Covered
Q2026	HCPCS	Covered
N13.70	ICD10CM	Covered
N13.9	ICD10CM	Covered