Aetna · PayerPolicy · AETNA-CPB-0564
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 |
|---|---|---|
| 92584 | CPT | Covered |
| A11 | ICD10CM | Covered |
| A12 | ICD10CM | Covered |
| H81.01 | ICD10CM | Covered |
| H81.09 | ICD10CM | Covered |
| H81.10 | ICD10CM | Covered |
| H81.13 | ICD10CM | Covered |
| H81.311 | ICD10CM | Covered |
| H81.49 | ICD10CM | Covered |
| H83. | ICD10CM | Covered |
| H83.11 | ICD10CM | Covered |
| H83.19 | ICD10CM | Covered |
| H90. | ICD10CM | Covered |
| H90.3 | ICD10CM | Covered |
| H90.41 | ICD10CM | Covered |
| H90.42 | ICD10CM | Covered |
| H90.5 | ICD10CM | Covered |
| H90.6 | ICD10CM | Covered |
| H90.8 | ICD10CM | Covered |
| H91. | ICD10CM | Covered |
| H91.20 | ICD10CM | Covered |
| H91.23 | ICD10CM | Covered |
| H93. | ICD10CM | Covered |
| H93.11 | ICD10CM | Covered |
| H93.19 | ICD10CM | Covered |
| R26.89 | ICD10CM | Covered |
| R42 | ICD10CM | Covered |
| S09. | ICD10CM | Covered |
| Z01.10 | ICD10CM | Covered |
| Z01.110 | ICD10CM | Covered |