Aetna · PayerPolicy · AETNA-CPB-0636
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 |
|---|---|---|
| E64.3 | ICD10CM | Covered |
| G57.60 | ICD10CM | Covered |
| G57.63 | ICD10CM | Covered |
| L97.501 | ICD10CM | Covered |
| L97.529 | ICD10CM | Covered |
| M12.271 | ICD10CM | Covered |
| M12.279 | ICD10CM | Covered |
| M20. | ICD10CM | Covered |
| M20.40 | ICD10CM | Covered |
| M20.42 | ICD10CM | Covered |
| M20.62 | ICD10CM | Covered |
| M24.571 | ICD10CM | Covered |
| M24.576 | ICD10CM | Covered |
| M24.671 | ICD10CM | Covered |
| M24.676 | ICD10CM | Covered |
| M65.871 | ICD10CM | Covered |
| M65.879 | ICD10CM | Covered |
| M67.00 | ICD10CM | Covered |
| M67.02 | ICD10CM | Covered |
| M77.50 | ICD10CM | Covered |
| M77.52 | ICD10CM | Covered |
| M77.9 | ICD10CM | Covered |
| Q66.7 | ICD10CM | Covered |
| Q74.2 | ICD10CM | Covered |
| S92. | ICD10CM | Covered |
| S93. | ICD10CM | Covered |