Aetna · PayerPolicy · AETNA-CPB-0546
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 |
|---|---|---|
| 33946 | CPT | Covered |
| 33947 | CPT | Covered |
| 33948 | CPT | Covered |
| 33949 | CPT | Covered |
| 33951 | CPT | Covered |
| 33952 | CPT | Covered |
| 33953 | CPT | Covered |
| 33954 | CPT | Covered |
| 33955 | CPT | Covered |
| 33956 | CPT | Covered |
| 33957 | CPT | Covered |
| 33958 | CPT | Covered |
| 33959 | CPT | Covered |
| 33962 | CPT | Covered |
| 33963 | CPT | Covered |
| 33964 | CPT | Covered |
| 33965 | CPT | Covered |
| 33966 | CPT | Covered |
| 33969 | CPT | Covered |
| 33984 | CPT | Covered |
| 33985 | CPT | Covered |
| 33986 | CPT | Covered |
| 33987 | CPT | Covered |
| 33988 | CPT | Covered |
| 33989 | CPT | Covered |
| A22.1 | ICD10CM | Covered |
| A36.81 | ICD10CM | Covered |
| A37.01 | ICD10CM | Covered |
| A37.11 | ICD10CM | Covered |
| A37.81 | ICD10CM | Covered |
| A37.91 | ICD10CM | Covered |
| A39.52 | ICD10CM | Covered |
| A40.0 | ICD10CM | Covered |
| A40.9 | ICD10CM | Covered |
| A41.01 | ICD10CM | Covered |
| A41.9 | ICD10CM | Covered |
| A48.1 | ICD10CM | Covered |
| A52.06 | ICD10CM | Covered |
| B25.0 | ICD10CM | Covered |
| B33.22 | ICD10CM | Covered |
| B44.0 | ICD10CM | Covered |
| B58.81 | ICD10CM | Covered |
| B77.81 | ICD10CM | Covered |
| E66.2 | ICD10CM | Covered |
| J10.00 | ICD10CM | Covered |
| J12.89 | ICD10CM | Covered |
| J18.1 | ICD10CM | Covered |
| J18.8 | ICD10CM | Covered |
| J18.9 | ICD10CM | Covered |
| J70.5 | ICD10CM | Covered |
| J80 | ICD10CM | Covered |
| J95.1 | ICD10CM | Covered |
| J95.3 | ICD10CM | Covered |
| J95.821 | ICD10CM | Covered |
| J95.822 | ICD10CM | Covered |
| J96.00 | ICD10CM | Covered |
| J96.02 | ICD10CM | Covered |
| J96.20 | ICD10CM | Covered |
| J96.22 | ICD10CM | Covered |
| J96.90 | ICD10CM | Covered |
| J96.92 | ICD10CM | Covered |
| J98.4 | ICD10CM | Covered |
| P22.0 | ICD10CM | Covered |
| P24.01 | ICD10CM | Covered |
| P25.0 | ICD10CM | Covered |
| P25.8 | ICD10CM | Covered |
| P28.5 | ICD10CM | Covered |
| P29.30 | ICD10CM | Covered |
| P29.38 | ICD10CM | Covered |
| Q79.0 | ICD10CM | Covered |
| R06.03 | ICD10CM | Covered |
| R57.0 | ICD10CM | Covered |
| R65.21 | ICD10CM | Covered |
| S21.309 | ICD10CM | Covered |
| S27.321 | ICD10CM | Covered |
| S27.329 | ICD10CM | Covered |
| T20. | ICD10CM | Covered |
| T32.99 | ICD10CM | Covered |
| T36. | ICD10CM | Covered |
| T50.996S | ICD10CM | Covered |
| T86.20 | ICD10CM | Covered |
| T86.298 | ICD10CM | Covered |
| T86.810 | ICD10CM | Covered |
| T86.819 | ICD10CM | Covered |
| Z76.82 | ICD10CM | Covered |
| Z94.4 | ICD10CM | Covered |