Aetna · PayerPolicy · AETNA-CPB-0665
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 |
|---|---|---|
| 64555 | CPT | Covered |
| 64595 | CPT | Covered |
| 90867 | CPT | Covered |
| 90868 | CPT | Covered |
| 90869 | CPT | Covered |
| 92507 | CPT | Covered |
| 92508 | CPT | Covered |
| 95970 | CPT | Covered |
| 95975 | CPT | Covered |
| 97813 | CPT | Covered |
| 97814 | CPT | Covered |
| G0151 | HCPCS | Covered |
| S9131 | HCPCS | Covered |
| C71.0 | ICD10CM | Covered |
| C71.9 | ICD10CM | Covered |
| G20 | ICD10CM | Covered |
| G21.11 | ICD10CM | Covered |
| G21.9 | ICD10CM | Covered |
| G35 | ICD10CM | Covered |
| G54.0 | ICD10CM | Covered |
| G80.0 | ICD10CM | Covered |
| G80.9 | ICD10CM | Covered |
| R29.5 | ICD10CM | Covered |