Aetna · PayerPolicy · AETNA-CPB-0535
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 |
|---|---|---|
| 72195 | CPT | Covered |
| 72196 | CPT | Covered |
| 72197 | CPT | Covered |
| 74181 | CPT | Covered |
| 74182 | CPT | Covered |
| 74183 | CPT | Covered |
| 74261 | CPT | Covered |
| 74262 | CPT | Covered |
| 74263 | CPT | Covered |
| A29 | ICD10CM | Covered |
| C15.3 | ICD10CM | Covered |
| C17.0 | ICD10CM | Covered |
| C18.0 | ICD10CM | Covered |
| C18.9 | ICD10CM | Covered |
| C19 | ICD10CM | Covered |
| C20 | ICD10CM | Covered |
| C78.4 | ICD10CM | Covered |
| D00.1 | ICD10CM | Covered |
| D01.0 | ICD10CM | Covered |
| D01.2 | ICD10CM | Covered |
| D13.0 | ICD10CM | Covered |
| D13.39 | ICD10CM | Covered |
| K20.0 | ICD10CM | Covered |
| K31. | ICD10CM | Covered |
| K50.00 | ICD10CM | Covered |
| K50.919 | ICD10CM | Covered |
| K56.50 | ICD10CM | Covered |
| K56.52 | ICD10CM | Covered |
| K56.600 | ICD10CM | Covered |
| K56.699 | ICD10CM | Covered |
| K57.00 | ICD10CM | Covered |
| K57.20 | ICD10CM | Covered |
| K57.33 | ICD10CM | Covered |
| K57.93 | ICD10CM | Covered |
| K68.9 | ICD10CM | Covered |
| Q42.0 | ICD10CM | Covered |
| Q42.9 | ICD10CM | Covered |
| T41 | ICD10CM | Covered |
| T41. | ICD10CM | Covered |
| T41.205 | ICD10CM | Covered |
| T41.295 | ICD10CM | Covered |
| T88. | ICD10CM | Covered |
| Z00.00 | ICD10CM | Covered |
| Z00.01 | ICD10CM | Covered |
| Z12.10 | ICD10CM | Covered |
| Z12.11 | ICD10CM | Covered |
| Z12.12 | ICD10CM | Covered |
| Z12.13 | ICD10CM | Covered |
| Z15.09 | ICD10CM | Covered |
| Z79.01 | ICD10CM | Covered |
| Z80.0 | ICD10CM | Covered |
| Z88.4 | ICD10CM | Covered |