Aetna · PayerPolicy · AETNA-CPB-0628
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 |
|---|---|---|
| 76800 | CPT | Covered |
| G06.1 | ICD10CM | Covered |
| G54.0 | ICD10CM | Covered |
| G59 | ICD10CM | Covered |
| G60.0 | ICD10CM | Covered |
| G65.2 | ICD10CM | Covered |
| G70.00 | ICD10CM | Covered |
| G73.7 | ICD10CM | Covered |
| G96.0 | ICD10CM | Covered |
| G97.51 | ICD10CM | Covered |
| G97.61 | ICD10CM | Covered |
| G97.63 | ICD10CM | Covered |
| M41.00 | ICD10CM | Covered |
| M41.9 | ICD10CM | Covered |
| M50.00 | ICD10CM | Covered |
| M51. | ICD10CM | Covered |
| M51.9 | ICD10CM | Covered |
| M53.0 | ICD10CM | Covered |
| M53.9 | ICD10CM | Covered |
| M54.00 | ICD10CM | Covered |
| M54.9 | ICD10CM | Covered |
| P10.0 | ICD10CM | Covered |
| P10.3 | ICD10CM | Covered |
| P10.8 | ICD10CM | Covered |
| P10.9 | ICD10CM | Covered |
| P11.5 | ICD10CM | Covered |
| P52.0 | ICD10CM | Covered |
| P52.22 | ICD10CM | Covered |
| P52.3 | ICD10CM | Covered |
| P52.5 | ICD10CM | Covered |
| Q05.0 | ICD10CM | Covered |
| Q05.9 | ICD10CM | Covered |
| Q06.0 | ICD10CM | Covered |
| Q06.9 | ICD10CM | Covered |
| Q07.01 | ICD10CM | Covered |
| Q07.03 | ICD10CM | Covered |
| Q42.2 | ICD10CM | Covered |
| Q42.3 | ICD10CM | Covered |
| Q76.49 | ICD10CM | Covered |