Aetna · PayerPolicy · AETNA-CPB-0621
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 |
|---|---|---|
| C1874 | HCPCS | Covered |
| C1875 | HCPCS | Covered |
| K22.2 | ICD10CM | Covered |
| K31.1 | ICD10CM | Covered |
| K80.00 | ICD10CM | Covered |
| K87 | ICD10CM | Covered |
| M30.3 | ICD10CM | Covered |
| M31.4 | ICD10CM | Covered |
| N18.1 | ICD10CM | Covered |
| N18.9 | ICD10CM | Covered |
| Q24.5 | ICD10CM | Covered |
| Q40.0 | ICD10CM | Covered |
| R13.10 | ICD10CM | Covered |
| R13.19 | ICD10CM | Covered |
| T82. | ICD10CM | Covered |
| Z99.2 | ICD10CM | Covered |