Sialolithiasis (Salivary Stones) | Aetna | Backwork

Sialolithiasis (Salivary Stones)

Aetna · PayerPolicy · AETNA-CPB-0716

Status: Active
Effective: October 10, 2023
Last reviewed by Aetna: October 14, 2025
Last checked by Backwork: October 1, 2026

Summary of the payer’s published policy. Not a coverage determination — confirm with Aetna before submitting.

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Codes in this policy

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.

Codes this policy lists and each code’s status in the policy
Code	Code system	Status in this policy
42500	CPT	Covered
42505	CPT	Covered
70486	CPT	Covered
76391	CPT	Covered
76536	CPT	Covered
76982	CPT	Covered
76983	CPT	Covered
K11.20	ICD10CM	Covered
K11.23	ICD10CM	Covered
K11.5	ICD10CM	Covered