Aetna · PayerPolicy · AETNA-CPB-0634
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 |
|---|---|---|
| B12 | ICD10CM | Covered |
| C43.0 | ICD10CM | Covered |
| C43.9 | ICD10CM | Covered |
| C50.011 | ICD10CM | Covered |
| C50.929 | ICD10CM | Covered |
| C62.00 | ICD10CM | Covered |
| C62.92 | ICD10CM | Covered |
| C64.1 | ICD10CM | Covered |
| C65.9 | ICD10CM | Covered |
| C74.00 | ICD10CM | Covered |
| C74.92 | ICD10CM | Covered |
| C81.00 | ICD10CM | Covered |
| C81.99 | ICD10CM | Covered |
| C82.50 | ICD10CM | Covered |
| C82.59 | ICD10CM | Covered |
| C83.10 | ICD10CM | Covered |
|---|
| C83.19 | ICD10CM | Covered |
|---|
| C83.30 | ICD10CM | Covered |
|---|
| C83.39 | ICD10CM | Covered |
|---|
| C83.80 | ICD10CM | Covered |
|---|
| C83.89 | ICD10CM | Covered |
|---|
| C84. | ICD10CM | Covered |
|---|
| C84.40 | ICD10CM | Covered |
|---|
| C84.49 | ICD10CM | Covered |
|---|
| C84.60 | ICD10CM | Covered |
|---|
| C84.7A | ICD10CM | Covered |
|---|
| C84.90 | ICD10CM | Covered |
|---|
| C84.99 | ICD10CM | Covered |
|---|
| C85.10 | ICD10CM | Covered |
|---|
| C85.99 | ICD10CM | Covered |
|---|
| C88.4 | ICD10CM | Covered |
|---|
| C90.00 | ICD10CM | Covered |
|---|
| C90.01 | ICD10CM | Covered |
|---|
| C91.00 | ICD10CM | Covered |
|---|
| C91.01 | ICD10CM | Covered |
|---|
| C91.10 | ICD10CM | Covered |
|---|
| C91.11 | ICD10CM | Covered |
|---|
| C92.00 | ICD10CM | Covered |
|---|
| C92.01 | ICD10CM | Covered |
|---|
| D45 | ICD10CM | Covered |
|---|
| D46.0 | ICD10CM | Covered |
|---|
| D46.9 | ICD10CM | Covered |
|---|
| D47.3 | ICD10CM | Covered |
|---|
| D51.0 | ICD10CM | Covered |
|---|
| D56.1 | ICD10CM | Covered |
|---|
| D57.0 | ICD10CM | Covered |
|---|
| D57.40 | ICD10CM | Covered |
|---|
| D57.411 | ICD10CM | Covered |
|---|
| D57.419 | ICD10CM | Covered |
|---|
| D57.819 | ICD10CM | Covered |
|---|
| D59.5 | ICD10CM | Covered |
|---|
| D60.0 | ICD10CM | Covered |
|---|
| D64.9 | ICD10CM | Covered |
|---|
| D75.81 | ICD10CM | Covered |
|---|
| D76.1 | ICD10CM | Covered |
|---|
| D80.0 | ICD10CM | Covered |
|---|
| D89.9 | ICD10CM | Covered |
|---|
| E10.10 | ICD10CM | Covered |
|---|
| E10.9 | ICD10CM | Covered |
|---|
| G35 | ICD10CM | Covered |
|---|
| G70.00 | ICD10CM | Covered |
|---|
| G70.01 | ICD10CM | Covered |
|---|
| L93.0 | ICD10CM | Covered |
|---|
| L93.2 | ICD10CM | Covered |
|---|
| M02.30 | ICD10CM | Covered |
|---|
| M02.39 | ICD10CM | Covered |
|---|
| M05.00 | ICD10CM | Covered |
|---|
| M06.9 | ICD10CM | Covered |
|---|
| M08.00 | ICD10CM | Covered |
|---|
| M08.99 | ICD10CM | Covered |
|---|
| M12.00 | ICD10CM | Covered |
|---|
| M12.09 | ICD10CM | Covered |
|---|
| M32.10 | ICD10CM | Covered |
|---|
| M32.9 | ICD10CM | Covered |
|---|
| M33.00 | ICD10CM | Covered |
|---|
| M33.9 | ICD10CM | Covered |
|---|
| M34.0 | ICD10CM | Covered |
|---|
| M34.9 | ICD10CM | Covered |
|---|
| M35.00 | ICD10CM | Covered |
|---|
| M35.9 | ICD10CM | Covered |
|---|
| M36.0 | ICD10CM | Covered |
|---|
| Q06.0 | ICD10CM | Covered |
|---|
| Q06.9 | ICD10CM | Covered |
|---|
| T78. | ICD10CM | Covered |
|---|