Aetna · PayerPolicy · AETNA-CPB-0553
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 |
|---|---|---|
| 83655 | CPT | Covered |
| D50 | ICD10CM | Covered |
| D50.0 | ICD10CM | Covered |
| D50.9 | ICD10CM | Covered |
| F50.81 | ICD10CM | Covered |
| F50.89 | ICD10CM | Covered |
| F80.0 | ICD10CM | Covered |
| F89 | ICD10CM | Covered |
| F98.3 | ICD10CM | Covered |
| G40.001 | ICD10CM | Covered |
| G40.919 | ICD10CM | Covered |
| G44.1 | ICD10CM | Covered |
| H90.0 | ICD10CM | Covered |
| H91.93 | ICD10CM | Covered |
| K59.00 | ICD10CM | Covered |
| K59.09 | ICD10CM | Covered |
| R10.0 | ICD10CM | Covered |
| R10.13 | ICD10CM | Covered |
| R10.30 | ICD10CM | Covered |
| R10.829 | ICD10CM | Covered |
| R10.84 | ICD10CM | Covered |
| R10.9 | ICD10CM | Covered |
| R11.0 | ICD10CM | Covered |
| R11.2 | ICD10CM | Covered |
| R27.0 | ICD10CM | Covered |
| R40.20 | ICD10CM | Covered |
| R40.3 | ICD10CM | Covered |
| R40.4 | ICD10CM | Covered |
| R51 | ICD10CM | Covered |
| R53.0 | ICD10CM | Covered |
| R53.1 | ICD10CM | Covered |
| R53.81 | ICD10CM | Covered |
| R53.83 | ICD10CM | Covered |
| R56.9 | ICD10CM | Covered |
| R62.0 | ICD10CM | Covered |
| R62.59 | ICD10CM | Covered |
| R63.0 | ICD10CM | Covered |
| T56. | ICD10CM | Covered |
| T56.0X | ICD10CM | Covered |
| T74.02X | ICD10CM | Covered |
| T74.92X | ICD10CM | Covered |
| Z00.121 | ICD10CM | Covered |
| Z13 | ICD10CM | Covered |
| Z33.1 | ICD10CM | Covered |
| Z34.0 | ICD10CM | Covered |
| Z34.93 | ICD10CM | Covered |
| Z57.2 | ICD10CM | Covered |
| Z57.4 | ICD10CM | Covered |
| Z57.8 | ICD10CM | Covered |
| Z77.011 | ICD10CM | Covered |