Aetna · PayerPolicy · AETNA-CPB-0583
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 |
|---|---|---|
| 90832 | CPT | Covered |
| 90899 | CPT | Covered |
| C00.0 | ICD10CM | Covered |
| C96.9 | ICD10CM | Covered |
| D00.0 | ICD10CM | Covered |
| D49.9 | ICD10CM | Covered |
| D89.89 | ICD10CM | Covered |
| F01.50 | ICD10CM | Covered |
| F43.0 | ICD10CM | Covered |
| F43.10 | ICD10CM | Covered |
| F43.12 | ICD10CM | Covered |
| F43.20 | ICD10CM | Covered |
| F99 | ICD10CM | Covered |
| G30.0 | ICD10CM | Covered |
| G30.09 | ICD10CM | Covered |
| G31.01 | ICD10CM | Covered |
| G31.09 | ICD10CM | Covered |
| G31.1 | ICD10CM | Covered |
| G31.2 | ICD10CM | Covered |
| G31.81 | ICD10CM | Covered |
| G31.89 | ICD10CM | Covered |
| G31.9 | ICD10CM | Covered |
| G32.0 | ICD10CM | Covered |
| G32.81 | ICD10CM | Covered |
| G32.89 | ICD10CM | Covered |
| G35 | ICD10CM | Covered |
| G47.00 | ICD10CM | Covered |
| G47.09 | ICD10CM | Covered |
| G47.10 | ICD10CM | Covered |
| G47.19 | ICD10CM | Covered |
| G47.20 | ICD10CM | Covered |
| G47.29 | ICD10CM | Covered |
| G47.30 | ICD10CM | Covered |
| G47.39 | ICD10CM | Covered |
| G47.411 | ICD10CM | Covered |
| G47.419 | ICD10CM | Covered |
| G47.421 | ICD10CM | Covered |
| G47.429 | ICD10CM | Covered |
| G47.50 | ICD10CM | Covered |
| G47.59 | ICD10CM | Covered |
| G47.61 | ICD10CM | Covered |
| G47.69 | ICD10CM | Covered |
| G47.8 | ICD10CM | Covered |
| G47.9 | ICD10CM | Covered |
| G54.6 | ICD10CM | Covered |
| G54.7 | ICD10CM | Covered |
| G89.11 | ICD10CM | Covered |
| G89.18 | ICD10CM | Covered |
| G89.21 | ICD10CM | Covered |
| G89.29 | ICD10CM | Covered |
| G89.4 | ICD10CM | Covered |
| H93. | ICD10CM | Covered |
| H93.11 | ICD10CM | Covered |
| H93.19 | ICD10CM | Covered |
| M05.00 | ICD10CM | Covered |
| M06.9 | ICD10CM | Covered |
| M54.50 | ICD10CM | Covered |
| M54.59 | ICD10CM | Covered |
| M54.9 | ICD10CM | Covered |
| M79.7 | ICD10CM | Covered |
| N94.4 | ICD10CM | Covered |
| N94.5 | ICD10CM | Covered |
| N94.6 | ICD10CM | Covered |
| R37 | ICD10CM | Covered |
| R56.00 | ICD10CM | Covered |
| R56.9 | ICD10CM | Covered |
| Z86.51 | ICD10CM | Covered |
| Z88.8 | ICD10CM | Covered |