Aetna · PayerPolicy · AETNA-CPB-0653
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 |
|---|---|---|
| 90471 | CPT | Covered |
| 90472 | CPT | Covered |
| 90696 | CPT | Covered |
| 90697 | CPT | Covered |
| 90698 | CPT | Covered |
| 90700 | CPT | Covered |
| 90702 | CPT | Covered |
| 90714 | CPT | Covered |
| 90715 | CPT | Covered |
| 90723 | CPT | Covered |
| S00. | ICD10CM | Covered |
| S01. | ICD10CM | Covered |
| S02. | ICD10CM | Covered |
| S02.600B | ICD10CM | Covered |
| S03. | ICD10CM | Covered |
| S06. | ICD10CM | Covered |
| S10. | ICD10CM | Covered |
| S11. | ICD10CM | Covered |
| S11.011 | ICD10CM | Covered |
| S12. | ICD10CM | Covered |
| S12.000B | ICD10CM | Covered |
| S12.691B | ICD10CM | Covered |
| S13.100 | ICD10CM | Covered |
| S13.181 | ICD10CM | Covered |
| S20. | ICD10CM | Covered |
| S21. | ICD10CM | Covered |
| S21.001 | ICD10CM | Covered |
| S21.301 | ICD10CM | Covered |
| S22. | ICD10CM | Covered |
| S22.000B | ICD10CM | Covered |
| S22.089B | ICD10CM | Covered |
| S23.100 | ICD10CM | Covered |
| S23.171 | ICD10CM | Covered |
| S23.420 | ICD10CM | Covered |
| S23.429 | ICD10CM | Covered |
| S30. | ICD10CM | Covered |
| S31.000 | ICD10CM | Covered |
| S31.600 | ICD10CM | Covered |
| S31.659 | ICD10CM | Covered |
| S31.839 | ICD10CM | Covered |
| S32. | ICD10CM | Covered |
| S32.000B | ICD10CM | Covered |
| S32.301B | ICD10CM | Covered |
| S33. | ICD10CM | Covered |
| S33.100 | ICD10CM | Covered |
| S40.011 | ICD10CM | Covered |
| S40.929 | ICD10CM | Covered |
| S41.001 | ICD10CM | Covered |
| S41.159 | ICD10CM | Covered |
| S42. | ICD10CM | Covered |
| S42.001B | ICD10CM | Covered |
| S43.001 | ICD10CM | Covered |
| S43.396 | ICD10CM | Covered |
| S50. | ICD10CM | Covered |
| S50.919 | ICD10CM | Covered |
| S51.001 | ICD10CM | Covered |
| S51.859 | ICD10CM | Covered |
| S52. | ICD10CM | Covered |
| S52.001B | ICD10CM | Covered |
| S53.001 | ICD10CM | Covered |
| S53.196 | ICD10CM | Covered |
| S60. | ICD10CM | Covered |
| S60.949 | ICD10CM | Covered |
| S61.001 | ICD10CM | Covered |
| S61.559 | ICD10CM | Covered |
| S62.001B | ICD10CM | Covered |
| S63.001 | ICD10CM | Covered |
| S63.299 | ICD10CM | Covered |
| S69. | ICD10CM | Covered |
| S70. | ICD10CM | Covered |
| S70.929 | ICD10CM | Covered |
| S71.001 | ICD10CM | Covered |
| S71.159 | ICD10CM | Covered |
| S72. | ICD10CM | Covered |
| S72.001B | ICD10CM | Covered |
| S73.001 | ICD10CM | Covered |
| S73.199 | ICD10CM | Covered |
| S80. | ICD10CM | Covered |
| S80.929 | ICD10CM | Covered |
| S81.001 | ICD10CM | Covered |
| S81.859 | ICD10CM | Covered |
| S82. | ICD10CM | Covered |
| S82.001B | ICD10CM | Covered |
| S83.001 | ICD10CM | Covered |
| S83.196 | ICD10CM | Covered |
| S90. | ICD10CM | Covered |
| S90.936 | ICD10CM | Covered |
| S91.001 | ICD10CM | Covered |
| S91.359 | ICD10CM | Covered |
| S92.001B | ICD10CM | Covered |
| S92.919B | ICD10CM | Covered |
| S93. | ICD10CM | Covered |
| S93.336 | ICD10CM | Covered |
| T20. | ICD10CM | Covered |
| T32.99 | ICD10CM | Covered |
| Z23 | ICD10CM | Covered |