Aetna · PayerPolicy · AETNA-CPB-0645
Summary of the payer’s published policy. Not a coverage determination — confirm with Aetna before submitting.
Free account. Policy pages stay open to everyone.
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 |
|---|---|---|
| 27702 | CPT | Covered |
| 27703 | CPT | Covered |
| A02.23 | ICD10CM | Covered |
| A39.83 | ICD10CM | Covered |
| A39.84 | ICD10CM | Covered |
| A48.0 | ICD10CM | Covered |
| A51.46 | ICD10CM | Covered |
| A52.11 | ICD10CM | Covered |
| A52.16 | ICD10CM | Covered |
| A52.77 | ICD10CM | Covered |
| A54.40 | ICD10CM | Covered |
| A54.49 | ICD10CM | Covered |
| B06.82 | ICD10CM | Covered |
| E66.01 | ICD10CM | Covered |
| E66.9 | ICD10CM | Covered |
| F01.50 | ICD10CM | Covered |
| F99 | ICD10CM | Covered |
| G57.00 | ICD10CM | Covered |
| G57.93 | ICD10CM | Covered |
| G70.00 | ICD10CM | Covered |
| G70.9 | ICD10CM | Covered |
| G73.1 | ICD10CM | Covered |
| G73.3 | ICD10CM | Covered |
| L89.500 | ICD10CM | Covered |
| L89.529 | ICD10CM | Covered |
| L97.301 | ICD10CM | Covered |
| L97.329 | ICD10CM | Covered |
| M00. | ICD10CM | Covered |
| M01. | ICD10CM | Covered |
| M02. | ICD10CM | Covered |
| M05.071 | ICD10CM | Covered |
| M05.079 | ICD10CM | Covered |
| M05.271 | ICD10CM | Covered |
| M05.279 | ICD10CM | Covered |
| M05.371 | ICD10CM | Covered |
| M05.379 | ICD10CM | Covered |
| M05.471 | ICD10CM | Covered |
| M05.479 | ICD10CM | Covered |
| M05.571 | ICD10CM | Covered |
| M05.579 | ICD10CM | Covered |
| M05.671 | ICD10CM | Covered |
| M05.679 | ICD10CM | Covered |
| M05.771 | ICD10CM | Covered |
| M05.779 | ICD10CM | Covered |
| M05.871 | ICD10CM | Covered |
| M05.879 | ICD10CM | Covered |
| M06.071 | ICD10CM | Covered |
| M06.079 | ICD10CM | Covered |
| M06.271 | ICD10CM | Covered |
| M06.279 | ICD10CM | Covered |
| M06.371 | ICD10CM | Covered |
| M06.379 | ICD10CM | Covered |
| M06.871 | ICD10CM | Covered |
| M06.879 | ICD10CM | Covered |
| M08.071 | ICD10CM | Covered |
| M08.079 | ICD10CM | Covered |
| M08.271 | ICD10CM | Covered |
| M08.279 | ICD10CM | Covered |
| M08.471 | ICD10CM | Covered |
| M08.479 | ICD10CM | Covered |
| M08.871 | ICD10CM | Covered |
| M08.879 | ICD10CM | Covered |
| M08.971 | ICD10CM | Covered |
| M08.979 | ICD10CM | Covered |
| M12.071 | ICD10CM | Covered |
| M12.079 | ICD10CM | Covered |
| M12.571 | ICD10CM | Covered |
| M12.579 | ICD10CM | Covered |
| M14.671 | ICD10CM | Covered |
| M14.679 | ICD10CM | Covered |
| M19.071 | ICD10CM | Covered |
| M19.079 | ICD10CM | Covered |
| M19.171 | ICD10CM | Covered |
| M19.179 | ICD10CM | Covered |
| M19.271 | ICD10CM | Covered |
| M19.279 | ICD10CM | Covered |
| M21. | ICD10CM | Covered |
| M24. | ICD10CM | Covered |
| M25. | ICD10CM | Covered |
| M81.0 | ICD10CM | Covered |
| M81.8 | ICD10CM | Covered |
| M86. | ICD10CM | Covered |
| M87. | ICD10CM | Covered |
| M97. | ICD10CM | Covered |
| Q66. | ICD10CM | Covered |
| Q68. | ICD10CM | Covered |
| T81. | ICD10CM | Covered |
| T84. | ICD10CM | Covered |
| T84.018 | ICD10CM | Covered |
| T84.028 | ICD10CM | Covered |
| T84.038 | ICD10CM | Covered |
| T84.058 | ICD10CM | Covered |
| T84.068 | ICD10CM | Covered |
| Z98.1 | ICD10CM | Covered |