Aetna · PayerPolicy · AETNA-CPB-0594
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 |
|---|---|---|
| 67221 | CPT | Covered |
| 67225 | CPT | Covered |
| 92133 | CPT | Covered |
| 92134 | CPT | Covered |
| 92235 | CPT | Covered |
| 96567 | CPT | Covered |
| 96570 | CPT | Covered |
| 96571 | CPT | Covered |
| 96573 | CPT | Covered |
| 96574 | CPT | Covered |
| J3396 | HCPCS | Covered |
| B39.4 | ICD10CM | Covered |
| B39.5 | ICD10CM | Covered |
| B39.9 | ICD10CM | Covered |
| C15.3 | ICD10CM | Covered |
| C15.9 | ICD10CM | Covered |
| C18.0 | ICD10CM | Covered |
| C18.9 | ICD10CM | Covered |
| C25.0 | ICD10CM | Covered |
| C25.9 | ICD10CM | Covered |
| C50. | ICD10CM | Covered |
| C54.1 | ICD10CM | Covered |
| C56. | ICD10CM | Covered |
| C69.20 | ICD10CM | Covered |
| C69.32 | ICD10CM | Covered |
| C71.0 | ICD10CM | Covered |
| C71.9 | ICD10CM | Covered |
| C77.9 | ICD10CM | Covered |
| D18.09 | ICD10CM | Covered |
| D31.30 | ICD10CM | Covered |
| D31.32 | ICD10CM | Covered |
| E80.0 | ICD10CM | Covered |
| E80.29 | ICD10CM | Covered |
| H21. | ICD10CM | Covered |
| H31.8 | ICD10CM | Covered |
| H32 | ICD10CM | Covered |
| H35.051 | ICD10CM | Covered |
| H35.059 | ICD10CM | Covered |
| H35.071 | ICD10CM | Covered |
| H35.079 | ICD10CM | Covered |
| H35.20 | ICD10CM | Covered |
| H35.23 | ICD10CM | Covered |
| H35.30 | ICD10CM | Covered |
| H35.329 | ICD10CM | Covered |
| H35.711 | ICD10CM | Covered |
| H35.719 | ICD10CM | Covered |
| H44. | ICD10CM | Covered |
| H44.20 | ICD10CM | Covered |
| H44.23 | ICD10CM | Covered |
| K76.89 | ICD10CM | Covered |
| K83.1 | ICD10CM | Covered |
| L40. | ICD10CM | Covered |
| L63. | ICD10CM | Covered |