Aetna · PayerPolicy · AETNA-CPB-0681
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 |
|---|---|---|
| 66830 | CPT | Covered |
| 66984 | CPT | Covered |
| 76514 | CPT | Covered |
| B50.0 | ICD10CM | Covered |
| B54 | ICD10CM | Covered |
| H11.001 | ICD10CM | Covered |
| H11.069 | ICD10CM | Covered |
| H15.121 | ICD10CM | Covered |
| H15.129 | ICD10CM | Covered |
| H18.461 | ICD10CM | Covered |
| H18.469 | ICD10CM | Covered |
| H18.531 | ICD10CM | Covered |
| H18.539 | ICD10CM | Covered |
| H18.601 | ICD10CM | Covered |
| H18.629 | ICD10CM | Covered |
| H25.011 | ICD10CM | Covered |
| H26.9 | ICD10CM | Covered |
| H28 | ICD10CM | Covered |
| H40.1410 | ICD10CM | Covered |
| H40.1494 | ICD10CM | Covered |
| M05.40 | ICD10CM | Covered |
| M06.9 | ICD10CM | Covered |
| M32.0 | ICD10CM | Covered |
| Q12.0 | ICD10CM | Covered |
| Q87.40 | ICD10CM | Covered |
| Q87.43 | ICD10CM | Covered |
| T37. | ICD10CM | Covered |
| Z13.5 | ICD10CM | Covered |