Aetna · PayerPolicy · AETNA-CPB-0697
Summary of the payer’s published policy. Not a coverage determination — confirm with Aetna before submitting.
Free account. Policy pages stay open to everyone.
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 |
|---|---|---|
| 22100 | CPT | Covered |
| 22103 | CPT | Covered |
| 22110 | CPT | Covered |
| 22116 | CPT | Covered |
| 22210 | CPT | Covered |
| 22216 | CPT | Covered |
| 22220 | CPT | Covered |
| 22226 | CPT | Covered |
| 22548 | CPT | Covered |
| 34717 | CPT | Covered |
| 34718 | CPT | Covered |
| 61343 | CPT | Covered |
| 61531 | CPT | Covered |
| 61533 | CPT | Covered |
| 61575 | CPT | Covered |
| 61576 | CPT | Covered |
| 62164 | CPT | Covered |
| 62165 | CPT | Covered |
| 63001 | CPT | Covered |
| 63650 | CPT | Covered |
| 63655 | CPT | Covered |
| 63663 | CPT | Covered |
| 63664 | CPT | Covered |
| 63685 | CPT | Covered |
| 63688 | CPT | Covered |
| 69930 | CPT | Covered |
| 92517 | CPT | Covered |
| 92519 | CPT | Covered |
| 92650 | CPT | Covered |
| 92651 | CPT | Covered |
| 92652 | CPT | Covered |
| 92653 | CPT | Covered |
| 95928 | CPT | Covered |
| 95929 | CPT | Covered |
| 95939 | CPT | Covered |
| C7555 | HCPCS | Covered |
| G0259 | HCPCS | Covered |
| G0260 | HCPCS | Covered |
| S2348 | HCPCS | Covered |
| S2350 | HCPCS | Covered |
| S2351 | HCPCS | Covered |
| A52.01 | ICD10CM | Covered |
| C07 | ICD10CM | Covered |
| C08.0 | ICD10CM | Covered |
| C19 | ICD10CM | Covered |
| C20 | ICD10CM | Covered |
| C30.1 | ICD10CM | Covered |
| C41.0 | ICD10CM | Covered |
| C41.2 | ICD10CM | Covered |
| C41.4 | ICD10CM | Covered |
| C44.201 | ICD10CM | Covered |
| C44.299 | ICD10CM | Covered |
| C47.0 | ICD10CM | Covered |
| C49.0 | ICD10CM | Covered |
| C61 | ICD10CM | Covered |
| C70.0 | ICD10CM | Covered |
| C70.9 | ICD10CM | Covered |
| C71.0 | ICD10CM | Covered |
| C71.7 | ICD10CM | Covered |
| C71.9 | ICD10CM | Covered |
| C72.0 | ICD10CM | Covered |
| C72.1 | ICD10CM | Covered |
| C72.9 | ICD10CM | Covered |
| C76.0 | ICD10CM | Covered |
| C78.5 | ICD10CM | Covered |
| C79.31 | ICD10CM | Covered |
| C79.32 | ICD10CM | Covered |
| C79.49 | ICD10CM | Covered |
| D00.0 | ICD10CM | Covered |
| D00.08 | ICD10CM | Covered |
| D01.2 | ICD10CM | Covered |
| D04.20 | ICD10CM | Covered |
| D04.22 | ICD10CM | Covered |
| D11.0 | ICD10CM | Covered |
| D11.9 | ICD10CM | Covered |
| D14.0 | ICD10CM | Covered |
| D16.6 | ICD10CM | Covered |
| D16.8 | ICD10CM | Covered |
| D21.0 | ICD10CM | Covered |
| D22.20 | ICD10CM | Covered |
| D22.22 | ICD10CM | Covered |
| D23.20 | ICD10CM | Covered |
| D23.22 | ICD10CM | Covered |
| D32.0 | ICD10CM | Covered |
| D32.9 | ICD10CM | Covered |
| D33.0 | ICD10CM | Covered |
| D33.3 | ICD10CM | Covered |
| D33.4 | ICD10CM | Covered |
| D36.10 | ICD10CM | Covered |
| D37.030 | ICD10CM | Covered |
| D37.039 | ICD10CM | Covered |
| D42.0 | ICD10CM | Covered |
| D43.0 | ICD10CM | Covered |
| D43.2 | ICD10CM | Covered |
| D43.3 | ICD10CM | Covered |
| D43.4 | ICD10CM | Covered |
| D49.0 | ICD10CM | Covered |
| D49.6 | ICD10CM | Covered |
| E00.0 | ICD10CM | Covered |
| E07.9 | ICD10CM | Covered |
| G10 | ICD10CM | Covered |
| G23.0 | ICD10CM | Covered |
| G26 | ICD10CM | Covered |
| G40.001 | ICD10CM | Covered |
| G40.919 | ICD10CM | Covered |
| G50.0 | ICD10CM | Covered |
| G50.8 | ICD10CM | Covered |
| G50.9 | ICD10CM | Covered |
| G51.0 | ICD10CM | Covered |
| G51.8 | ICD10CM | Covered |
| G52.9 | ICD10CM | Covered |
| G93.5 | ICD10CM | Covered |
| G93.6 | ICD10CM | Covered |
| H47.091 | ICD10CM | Covered |
| H47.099 | ICD10CM | Covered |
| H71.00 | ICD10CM | Covered |
| H71.93 | ICD10CM | Covered |
| H74.40 | ICD10CM | Covered |
| H74.43 | ICD10CM | Covered |
| H81.01 | ICD10CM | Covered |
| H81.09 | ICD10CM | Covered |
| H81.391 | ICD10CM | Covered |
| H81.399 | ICD10CM | Covered |
| H81.41 | ICD10CM | Covered |
| H81.49 | ICD10CM | Covered |
| H93. | ICD10CM | Covered |
| H95.00 | ICD10CM | Covered |
| H95.03 | ICD10CM | Covered |
| K11.0 | ICD10CM | Covered |
| K11.9 | ICD10CM | Covered |
| M26.00 | ICD10CM | Covered |
| M26.9 | ICD10CM | Covered |
| M41.00 | ICD10CM | Covered |
| M41.05 | ICD10CM | Covered |
| M41.112 | ICD10CM | Covered |
| M41.115 | ICD10CM | Covered |
| M41.122 | ICD10CM | Covered |
| M41.125 | ICD10CM | Covered |
| M41.26 | ICD10CM | Covered |
| M41.27 | ICD10CM | Covered |
| M41.30 | ICD10CM | Covered |
| M41.35 | ICD10CM | Covered |
| M41.41 | ICD10CM | Covered |
| M41.45 | ICD10CM | Covered |
| M41.52 | ICD10CM | Covered |
| M41.55 | ICD10CM | Covered |
| M41.82 | ICD10CM | Covered |
| M41.85 | ICD10CM | Covered |
| M47.14 | ICD10CM | Covered |
| M47.15 | ICD10CM | Covered |
| M47.16 | ICD10CM | Covered |
| M50.00 | ICD10CM | Covered |
| M50.03 | ICD10CM | Covered |
| M51.04 | ICD10CM | Covered |
| M51.05 | ICD10CM | Covered |
| M51.06 | ICD10CM | Covered |
| M54.05 | ICD10CM | Covered |
| M75.100 | ICD10CM | Covered |
| M75.122 | ICD10CM | Covered |
| M96.1 | ICD10CM | Covered |
| M96.5 | ICD10CM | Covered |
| N35.010 | ICD10CM | Covered |
| N35.92 | ICD10CM | Covered |
| N40.0 | ICD10CM | Covered |
| N40.3 | ICD10CM | Covered |
| N99.110 | ICD10CM | Covered |
| N99.12 | ICD10CM | Covered |
| P91.0 | ICD10CM | Covered |
| P91.1 | ICD10CM | Covered |
| P91.3 | ICD10CM | Covered |
| P91.5 | ICD10CM | Covered |
| Q01.0 | ICD10CM | Covered |
| Q01.9 | ICD10CM | Covered |
| Q04.0 | ICD10CM | Covered |
| Q04.3 | ICD10CM | Covered |
| Q07.00 | ICD10CM | Covered |
| Q07.03 | ICD10CM | Covered |
| Q28.2 | ICD10CM | Covered |
| Q28.8 | ICD10CM | Covered |
| Q65.89 | ICD10CM | Covered |
| Q67.5 | ICD10CM | Covered |
| Q67.6 | ICD10CM | Covered |
| Q75.0 | ICD10CM | Covered |
| Q75.9 | ICD10CM | Covered |
| Q76.3 | ICD10CM | Covered |
| Q76.425 | ICD10CM | Covered |
| Q76.429 | ICD10CM | Covered |
| R25.0 | ICD10CM | Covered |
| R25.9 | ICD10CM | Covered |
| R40.20 | ICD10CM | Covered |
| R40.236 | ICD10CM | Covered |
| R42 | ICD10CM | Covered |
| R56.9 | ICD10CM | Covered |
| S02. | ICD10CM | Covered |
| S02.600 | ICD10CM | Covered |
| S06. | ICD10CM | Covered |
| S12. | ICD10CM | Covered |
| S12.000 | ICD10CM | Covered |
| S14. | ICD10CM | Covered |
| S14.159 | ICD10CM | Covered |
| S22.000 | ICD10CM | Covered |
| S22.089 | ICD10CM | Covered |
| S24. | ICD10CM | Covered |
| S24.159 | ICD10CM | Covered |
| S32. | ICD10CM | Covered |
| S32.000 | ICD10CM | Covered |
| S34. | ICD10CM | Covered |
| S34.139 | ICD10CM | Covered |
| T84. | ICD10CM | Covered |
| T84.010 | ICD10CM | Covered |
| Z47.2 | ICD10CM | Covered |
| Z51.89 | ICD10CM | Covered |