Aetna · PayerPolicy · AETNA-CPB-0541
Summary of the payer’s published policy. Not a coverage determination — confirm with Aetna before submitting.
Free account. Policy pages stay open to everyone.
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 |
|---|---|---|
| 83529 | CPT | Covered |
| 90935 | CPT | Covered |
| 90937 | CPT | Covered |
| 90945 | CPT | Covered |
| 90947 | CPT | Covered |
| 90999 | CPT | Covered |
| 99512 | CPT | Covered |
| A4216 | HCPCS | Covered |
| A4217 | HCPCS | Covered |
| A4651 | HCPCS | Covered |
| A4652 | HCPCS | Covered |
| A4653 | HCPCS | Covered |
| A4657 | HCPCS | Covered |
| A4660 | HCPCS | Covered |
| A4663 | HCPCS | Covered |
| A4670 | HCPCS | Covered |
| A4671 | HCPCS | Covered |
| A4672 | HCPCS | Covered |
| A4673 | HCPCS | Covered |
| A4674 | HCPCS | Covered |
| A4680 | HCPCS | Covered |
| A4690 | HCPCS | Covered |
| A4706 | HCPCS | Covered |
| A4707 | HCPCS | Covered |
| A4708 | HCPCS | Covered |
| A4709 | HCPCS | Covered |
| A4714 | HCPCS | Covered |
| A4720 | HCPCS | Covered |
| A4726 | HCPCS | Covered |
| A4728 | HCPCS | Covered |
| A4730 | HCPCS | Covered |
| A4736 | HCPCS | Covered |
| A4737 | HCPCS | Covered |
| A4740 | HCPCS | Covered |
| A4750 | HCPCS | Covered |
| A4755 | HCPCS | Covered |
| A4760 | HCPCS | Covered |
| A4765 | HCPCS | Covered |
| A4766 | HCPCS | Covered |
| A4770 | HCPCS | Covered |
| A4771 | HCPCS | Covered |
| A4772 | HCPCS | Covered |
| A4773 | HCPCS | Covered |
| A4774 | HCPCS | Covered |
| A4802 | HCPCS | Covered |
| A4860 | HCPCS | Covered |
| A4870 | HCPCS | Covered |
| A4890 | HCPCS | Covered |
| A4911 | HCPCS | Covered |
| A4913 | HCPCS | Covered |
| A4918 | HCPCS | Covered |
| A4927 | HCPCS | Covered |
| A4928 | HCPCS | Covered |
| A4929 | HCPCS | Covered |
| A4930 | HCPCS | Covered |
| A6010 | HCPCS | Covered |
| A6457 | HCPCS | Covered |
| C1881 | HCPCS | Covered |
| E1500 | HCPCS | Covered |
| E1510 | HCPCS | Covered |
| E1520 | HCPCS | Covered |
| E1530 | HCPCS | Covered |
| E1540 | HCPCS | Covered |
| E1550 | HCPCS | Covered |
| E1560 | HCPCS | Covered |
| E1570 | HCPCS | Covered |
| E1575 | HCPCS | Covered |
| E1580 | HCPCS | Covered |
| E1590 | HCPCS | Covered |
| E1592 | HCPCS | Covered |
| E1594 | HCPCS | Covered |
| E1600 | HCPCS | Covered |
| E1610 | HCPCS | Covered |
| E1615 | HCPCS | Covered |
| E1620 | HCPCS | Covered |
| E1625 | HCPCS | Covered |
| E1629 | HCPCS | Covered |
| E1630 | HCPCS | Covered |
| E1632 | HCPCS | Covered |
| E1634 | HCPCS | Covered |
| E1635 | HCPCS | Covered |
| E1636 | HCPCS | Covered |
| E1637 | HCPCS | Covered |
| E1639 | HCPCS | Covered |
| E1699 | HCPCS | Covered |
| G0299 | HCPCS | Covered |
| G0300 | HCPCS | Covered |
| J1643 | HCPCS | Covered |
| J1644 | HCPCS | Covered |
| J7030 | HCPCS | Covered |
| J7040 | HCPCS | Covered |
| S9123 | HCPCS | Covered |
| S9124 | HCPCS | Covered |
| S9335 | HCPCS | Covered |
| S9339 | HCPCS | Covered |
| E83.39 | ICD10CM | Covered |
| E87.5 | ICD10CM | Covered |
| E87.70 | ICD10CM | Covered |
| E87.79 | ICD10CM | Covered |
| J81.0 | ICD10CM | Covered |
| J81.1 | ICD10CM | Covered |
| N18.6 | ICD10CM | Covered |
| R54 | ICD10CM | Covered |
| T82.858A | ICD10CM | Covered |
| T82.858S | ICD10CM | Covered |
| Z33.1 | ICD10CM | Covered |
| Z33.3 | ICD10CM | Covered |
| Z99.2 | ICD10CM | Covered |