Aetna · PayerPolicy · AETNA-CPB-0663
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 |
|---|---|---|
| 37195 | CPT | Covered |
| 61623 | CPT | Covered |
| 70450 | CPT | Covered |
| 70470 | CPT | Covered |
| 70496 | CPT | Covered |
| C9257 | HCPCS | Covered |
| J9035 | HCPCS | Covered |
| B00.4 | ICD10CM | Covered |
| C00.0 | ICD10CM | Covered |
| C14.8 | ICD10CM | Covered |
| C34.00 | ICD10CM | Covered |
| C34.92 | ICD10CM | Covered |
| C49.0 | ICD10CM | Covered |
| C71.0 | ICD10CM | Covered |
| C71.9 | ICD10CM | Covered |
| C72.0 | ICD10CM | Covered |
| C72.9 | ICD10CM | Covered |
| C76.0 | ICD10CM | Covered |
| C79.31 | ICD10CM | Covered |
| C79.49 | ICD10CM | Covered |
| C81.00 | ICD10CM | Covered |
| C88.9 | ICD10CM | Covered |
| G06.0 | ICD10CM | Covered |
| G07 | ICD10CM | Covered |
| G20 | ICD10CM | Covered |
| G30.0 | ICD10CM | Covered |
| G30.9 | ICD10CM | Covered |
| G31.84 | ICD10CM | Covered |
| G45.0 | ICD10CM | Covered |
| G45.9 | ICD10CM | Covered |
| G46.3 | ICD10CM | Covered |
| G46.8 | ICD10CM | Covered |
| G47.33 | ICD10CM | Covered |
| G89.21 | ICD10CM | Covered |
| G89.22 | ICD10CM | Covered |
| G89.28 | ICD10CM | Covered |
| G89.29 | ICD10CM | Covered |
| G89.3 | ICD10CM | Covered |
| G91.0 | ICD10CM | Covered |
| G91.2 | ICD10CM | Covered |
| G93.82 | ICD10CM | Covered |
| G97.81 | ICD10CM | Covered |
| Q28.0 | ICD10CM | Covered |
| Q28.2 | ICD10CM | Covered |
| R52 | ICD10CM | Covered |
| S02. | ICD10CM | Covered |
| S06. | ICD10CM | Covered |
| S09. | ICD10CM | Covered |
| T66. | ICD10CM | Covered |
| T88. | ICD10CM | Covered |
| Z13.858 | ICD10CM | Covered |