Aetna · PayerPolicy · AETNA-CPB-0618
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 |
|---|---|---|
| 83880 | CPT | Covered |
| A02.1 | ICD10CM | Covered |
| A22.7 | ICD10CM | Covered |
| A24.1 | ICD10CM | Covered |
| A26.7 | ICD10CM | Covered |
| A31.2 | ICD10CM | Covered |
| A32.7 | ICD10CM | Covered |
| A40.0 | ICD10CM | Covered |
| A40.9 | ICD10CM | Covered |
| A41.01 | ICD10CM | Covered |
| A41.9 | ICD10CM | Covered |
| A42.7 | ICD10CM | Covered |
| A54.86 | ICD10CM | Covered |
| B00.7 | ICD10CM | Covered |
| B37.7 | ICD10CM | Covered |
| D57.0 | ICD10CM | Covered |
| D57.819 | ICD10CM | Covered |
| E11.00 | ICD10CM | Covered |
| E13.9 | ICD10CM | Covered |
| F01. | ICD10CM | Covered |
| F01.50 | ICD10CM | Covered |
| G11.1 | ICD10CM | Covered |
| G45.0 | ICD10CM | Covered |
| G45.9 | ICD10CM | Covered |
| G93.0 | ICD10CM | Covered |
| G93.9 | ICD10CM | Covered |
| J40 | ICD10CM | Covered |
| J47.9 | ICD10CM | Covered |
| J86.0 | ICD10CM | Covered |
| J86.9 | ICD10CM | Covered |
| M30.3 | ICD10CM | Covered |
| M34.89 | ICD10CM | Covered |
| N18.1 | ICD10CM | Covered |
| N18.9 | ICD10CM | Covered |
| P27.1 | ICD10CM | Covered |
| P36.0 | ICD10CM | Covered |
| P36.9 | ICD10CM | Covered |
| Q20.0 | ICD10CM | Covered |
| Q28.9 | ICD10CM | Covered |
| Q79.0 | ICD10CM | Covered |
| R06.00 | ICD10CM | Covered |
| R06.09 | ICD10CM | Covered |
| R06.82 | ICD10CM | Covered |
| R41.81 | ICD10CM | Covered |
| R53.82 | ICD10CM | Covered |
| R65.20 | ICD10CM | Covered |
| R65.21 | ICD10CM | Covered |
| S06. | ICD10CM | Covered |
| T81. | ICD10CM | Covered |
| T88. | ICD10CM | Covered |
| Z01.810 | ICD10CM | Covered |
| Z13.6 | ICD10CM | Covered |
| Z13.89 | ICD10CM | Covered |
| Z99.11 | ICD10CM | Covered |