Aetna · PayerPolicy · AETNA-CPB-0599
Summary of the payer’s published policy. Not a coverage determination — confirm with Aetna before submitting.
Free account. Policy pages stay open to everyone.
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 |
|---|---|---|
| 64910 | CPT | Covered |
| 64911 | CPT | Covered |
| 64912 | CPT | Covered |
| 64913 | CPT | Covered |
| C9782 | HCPCS | Covered |
| A32 | ICD10CM | Covered |
| D89.810 | ICD10CM | Covered |
| D89.813 | ICD10CM | Covered |
| E08.00 | ICD10CM | Covered |
| E13.9 | ICD10CM | Covered |
| E28.39 | ICD10CM | Covered |
| G11.10 | ICD10CM | Covered |
| G11.19 | ICD10CM | Covered |
| G11.2 | ICD10CM | Covered |
| G11.3 | ICD10CM | Covered |
| G11.9 | ICD10CM | Covered |
| G32.81 | ICD10CM | Covered |
| G35 | ICD10CM | Covered |
| G40.001 | ICD10CM | Covered |
| G40.919 | ICD10CM | Covered |
| G71.01 | ICD10CM | Covered |
| H35.32 | ICD10CM | Covered |
| H90. | ICD10CM | Covered |
| H90.3 | ICD10CM | Covered |
| H90.41 | ICD10CM | Covered |
| J38.3 | ICD10CM | Covered |
| K50.00 | ICD10CM | Covered |
| K50.919 | ICD10CM | Covered |
| K70.2 | ICD10CM | Covered |
| K71.7 | ICD10CM | Covered |
| K72.00 | ICD10CM | Covered |
| K72.91 | ICD10CM | Covered |
| K74.0 | ICD10CM | Covered |
| K74.2 | ICD10CM | Covered |
| M05.10 | ICD10CM | Covered |
| M08.48 | ICD10CM | Covered |
| M17.0 | ICD10CM | Covered |
| M17.5 | ICD10CM | Covered |
| M45. | ICD10CM | Covered |
| M45.0 | ICD10CM | Covered |
| M48. | ICD10CM | Covered |
| M49.89 | ICD10CM | Covered |
| M75.100 | ICD10CM | Covered |
| M75.122 | ICD10CM | Covered |
| M76.50 | ICD10CM | Covered |
| M76.52 | ICD10CM | Covered |
| M77.10 | ICD10CM | Covered |
| M77.12 | ICD10CM | Covered |
| M79.2 | ICD10CM | Covered |
| M87.051 | ICD10CM | Covered |
| M87.059 | ICD10CM | Covered |
| M87.151 | ICD10CM | Covered |
| M87.159 | ICD10CM | Covered |
| M87.251 | ICD10CM | Covered |
| M87.256 | ICD10CM | Covered |
| M87.351 | ICD10CM | Covered |
| M87.353 | ICD10CM | Covered |
| M87.851 | ICD10CM | Covered |
| M87.859 | ICD10CM | Covered |
| M90.551 | ICD10CM | Covered |
| M90.559 | ICD10CM | Covered |
| N17.0 | ICD10CM | Covered |
| N17.9 | ICD10CM | Covered |
| N18.1 | ICD10CM | Covered |
| N18.9 | ICD10CM | Covered |
| N39.3 | ICD10CM | Covered |
| S01. | ICD10CM | Covered |
| S11. | ICD10CM | Covered |
| S11.011A | ICD10CM | Covered |
| S14.101A | ICD10CM | Covered |
| S14.159S | ICD10CM | Covered |
| S21. | ICD10CM | Covered |
| S21.001A | ICD10CM | Covered |
| S24.101A | ICD10CM | Covered |
| S24.159S | ICD10CM | Covered |
| S31.000A | ICD10CM | Covered |
| S31.839S | ICD10CM | Covered |
| S34.101A | ICD10CM | Covered |
| S34.139S | ICD10CM | Covered |
| S41.001A | ICD10CM | Covered |
| S41.159S | ICD10CM | Covered |
| S51.001A | ICD10CM | Covered |
| S51.859S | ICD10CM | Covered |
| S61.001A | ICD10CM | Covered |
| S61.559S | ICD10CM | Covered |
| S71.001A | ICD10CM | Covered |
| S71.159S | ICD10CM | Covered |
| S81.001A | ICD10CM | Covered |
| S81.859S | ICD10CM | Covered |
| S91.001A | ICD10CM | Covered |
| S91.359S | ICD10CM | Covered |
| T86.810 | ICD10CM | Covered |
| T86.819 | ICD10CM | Covered |