Aetna · PayerPolicy · AETNA-CPB-0715
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 |
|---|---|---|
| 81120 | CPT | Covered |
| 81121 | CPT | Covered |
| 81164 | CPT | Covered |
| 81167 | CPT | Covered |
| 81222 | CPT | Covered |
| 81227 | CPT | Covered |
| 81230 | CPT | Covered |
| 81231 | CPT | Covered |
| 81232 | CPT | Covered |
| 81245 | CPT | Covered |
| 81246 | CPT | Covered |
| 81272 | CPT | Covered |
| 81273 | CPT | Covered |
| 81275 | CPT | Covered |
| 81276 | CPT | Covered |
| 81283 | CPT | Covered |
| 81287 | CPT | Covered |
| 81291 | CPT | Covered |
| 81301 | CPT | Covered |
| 81309 | CPT | Covered |
| 81346 | CPT | Covered |
| 81350 | CPT | Covered |
| 81401 | CPT | Covered |
| 83789 | CPT | Covered |
| 84431 | CPT | Covered |
| 88271 | CPT | Covered |
| 88275 | CPT | Covered |
| 88341 | CPT | Covered |
| 88342 | CPT | Covered |
| A1298C | HCPCS | Covered |
| A1555G | HCPCS | Covered |
| G1244E | HCPCS | Covered |
| G1349D | HCPCS | Covered |
| G9143 | HCPCS | Covered |
| S1251N | HCPCS | Covered |
| S1255P | HCPCS | Covered |
| S3722 | HCPCS | Covered |
| A1298C | ICD10CM | Covered |
| A1555G | ICD10CM | Covered |
| A682G | ICD10CM | Covered |
| A692V | ICD10CM | Covered |
| B19.20 | ICD10CM | Covered |
| C00.0 | ICD10CM | Covered |
| C07 | ICD10CM | Covered |
| C08.0 | ICD10CM | Covered |
| C08.9 | ICD10CM | Covered |
| C09.0 | ICD10CM | Covered |
| C10.9 | ICD10CM | Covered |
| C12 | ICD10CM | Covered |
| C14.8 | ICD10CM | Covered |
| C15.3 | ICD10CM | Covered |
| C15.9 | ICD10CM | Covered |
| C16.0 | ICD10CM | Covered |
| C16.9 | ICD10CM | Covered |
| C17.0 | ICD10CM | Covered |
| C17.9 | ICD10CM | Covered |
| C18.0 | ICD10CM | Covered |
| C18.9 | ICD10CM | Covered |
| C19 | ICD10CM | Covered |
| C20 | ICD10CM | Covered |
| C21.0 | ICD10CM | Covered |
| C21.8 | ICD10CM | Covered |
| C22.0 | ICD10CM | Covered |
| C22.1 | ICD10CM | Covered |
| C23 | ICD10CM | Covered |
| C24.0 | ICD10CM | Covered |
| C24.9 | ICD10CM | Covered |
| C25.0 | ICD10CM | Covered |
| C25.9 | ICD10CM | Covered |
| C26 | ICD10CM | Covered |
| C30.0 | ICD10CM | Covered |
| C30.1 | ICD10CM | Covered |
| C31.0 | ICD10CM | Covered |
| C31.9 | ICD10CM | Covered |
| C32.0 | ICD10CM | Covered |
| C32.9 | ICD10CM | Covered |
| C34.00 | ICD10CM | Covered |
| C34.92 | ICD10CM | Covered |
| C37 | ICD10CM | Covered |
| C40.00 | ICD10CM | Covered |
| C41.9 | ICD10CM | Covered |
| C43.0 | ICD10CM | Covered |
| C43.9 | ICD10CM | Covered |
| C44.00 | ICD10CM | Covered |
| C44.02 | ICD10CM | Covered |
| C44.09 | ICD10CM | Covered |
| C44.101 | ICD10CM | Covered |
| C44.1992 | ICD10CM | Covered |
| C44.201 | ICD10CM | Covered |
| C44.299 | ICD10CM | Covered |
| C44.300 | ICD10CM | Covered |
| C44.399 | ICD10CM | Covered |
| C44.40 | ICD10CM | Covered |
| C44.49 | ICD10CM | Covered |
| C45.0 | ICD10CM | Covered |
| C48.0 | ICD10CM | Covered |
| C48.1 | ICD10CM | Covered |
| C48.2 | ICD10CM | Covered |
| C48.8 | ICD10CM | Covered |
| C49. | ICD10CM | Covered |
| C50.011 | ICD10CM | Covered |
| C50.92 | ICD10CM | Covered |
| C50.929 | ICD10CM | Covered |
| C51.0 | ICD10CM | Covered |
| C51.9 | ICD10CM | Covered |
| C53.0 | ICD10CM | Covered |
| C53.9 | ICD10CM | Covered |
| C54.0 | ICD10CM | Covered |
| C54.9 | ICD10CM | Covered |
| C56.1 | ICD10CM | Covered |
| C56.9 | ICD10CM | Covered |
| C57.00 | ICD10CM | Covered |
| C57.02 | ICD10CM | Covered |
| C58 | ICD10CM | Covered |
| C60.1 | ICD10CM | Covered |
| C60.9 | ICD10CM | Covered |
| C62.90 | ICD10CM | Covered |
| C62.92 | ICD10CM | Covered |
| C64.1 | ICD10CM | Covered |
| C64.9 | ICD10CM | Covered |
| C65.0 | ICD10CM | Covered |
| C65.1 | ICD10CM | Covered |
| C65.9 | ICD10CM | Covered |
| C66.0 | ICD10CM | Covered |
| C66.1 | ICD10CM | Covered |
| C66.9 | ICD10CM | Covered |
| C67.0 | ICD10CM | Covered |
| C67.9 | ICD10CM | Covered |
| C677T | ICD10CM | Covered |
| C68.0 | ICD10CM | Covered |
| C68.9 | ICD10CM | Covered |
| C69.40 | ICD10CM | Covered |
| C69.42 | ICD10CM | Covered |
| C71.0 | ICD10CM | Covered |
| C71.9 | ICD10CM | Covered |
| C73 | ICD10CM | Covered |
| C74.00 | ICD10CM | Covered |
| C74.92 | ICD10CM | Covered |
| C76.0 | ICD10CM | Covered |
| C78.89 | ICD10CM | Covered |
| C81.10 | ICD10CM | Covered |
| C81.79 | ICD10CM | Covered |
| C81.99 | ICD10CM | Covered |
| C84.00 | ICD10CM | Covered |
| C84.09 | ICD10CM | Covered |
| C84.10 | ICD10CM | Covered |
| C84.19 | ICD10CM | Covered |
| C85.20 | ICD10CM | Covered |
| C85.29 | ICD10CM | Covered |
| C86.0 | ICD10CM | Covered |
| C86.6 | ICD10CM | Covered |
| C90.00 | ICD10CM | Covered |
| C90.02 | ICD10CM | Covered |
| C91.10 | ICD10CM | Covered |
| C91.12 | ICD10CM | Covered |
| C91.90 | ICD10CM | Covered |
| C91.91 | ICD10CM | Covered |
| C92.00 | ICD10CM | Covered |
| C92.02 | ICD10CM | Covered |
| C92.10 | ICD10CM | Covered |
| C92.92 | ICD10CM | Covered |
| C93.10 | ICD10CM | Covered |
| C93.12 | ICD10CM | Covered |
| C96.21 | ICD10CM | Covered |
| D46.0 | ICD10CM | Covered |
| D46.9 | ICD10CM | Covered |
| D47.1 | ICD10CM | Covered |
| D816V | ICD10CM | Covered |
| E84.0 | ICD10CM | Covered |
| E84.9 | ICD10CM | Covered |
| F20 | ICD10CM | Covered |
| F39 | ICD10CM | Covered |
| F40 | ICD10CM | Covered |
| F40.00 | ICD10CM | Covered |
| F48 | ICD10CM | Covered |
| F48.9 | ICD10CM | Covered |
| F90.1 | ICD10CM | Covered |
| F90.9 | ICD10CM | Covered |
| G12.21 | ICD10CM | Covered |
| G1244E | ICD10CM | Covered |
| G12C | ICD10CM | Covered |
| G1349D | ICD10CM | Covered |
| G178R | ICD10CM | Covered |
| G30.0 | ICD10CM | Covered |
| G30.9 | ICD10CM | Covered |
| G551D | ICD10CM | Covered |
| G551S | ICD10CM | Covered |
| G89.21 | ICD10CM | Covered |
| G89.29 | ICD10CM | Covered |
| K21.0 | ICD10CM | Covered |
| K21.9 | ICD10CM | Covered |
| L858R | ICD10CM | Covered |
| P450 | ICD10CM | Covered |
| Q80K | ICD10CM | Covered |
| R117H | ICD10CM | Covered |
| S1251N | ICD10CM | Covered |
| S1255P | ICD10CM | Covered |
| S549N | ICD10CM | Covered |
| S549R | ICD10CM | Covered |
| T790 | ICD10CM | Covered |
| V600 | ICD10CM | Covered |
| V600E | ICD10CM | Covered |
| V600K | ICD10CM | Covered |
| Y646F | ICD10CM | Covered |
| Y646N | ICD10CM | Covered |
| Y646X | ICD10CM | Covered |
| Z20.6 | ICD10CM | Covered |
| Z20.828 | ICD10CM | Covered |
| Z51.81 | ICD10CM | Covered |
| Z79.82 | ICD10CM | Covered |
| Z98.61 | ICD10CM | Covered |