Histamine Desensitization Therapy for Intractable H… | Aetna

Histamine Desensitization Therapy for Intractable Headaches

Aetna · PayerPolicy · AETNA-CPB-0647

Status: Active
Effective: September 13, 2023
Last reviewed by Aetna: December 8, 2025
Last checked by Backwork: August 1, 2026

Summary of the payer’s published policy. Not a coverage determination — confirm with Aetna before submitting.

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Codes in this policy

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.

Codes this policy lists and each code’s status in the policy
Code	Code system	Status in this policy
96365	CPT	Covered
96379	CPT	Covered
G43.001	ICD10CM	Covered
G43.919	ICD10CM	Covered
G44.001	ICD10CM	Covered
G44.029	ICD10CM	Covered
G44.1	ICD10CM	Covered
G44.201	ICD10CM	Covered
G44.229	ICD10CM	Covered
R51	ICD10CM	Covered