Aetna · PayerPolicy · AETNA-CPB-0717
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 |
|---|---|---|
| A15.0 | ICD10CM | Covered |
| A19.9 | ICD10CM | Covered |
| B37.0 | ICD10CM | Covered |
| C00.0 | ICD10CM | Covered |
| C96.9 | ICD10CM | Covered |
| D00.1 | ICD10CM | Covered |
| D00.2 | ICD10CM | Covered |
| D05.00 | ICD10CM | Covered |
| D05.92 | ICD10CM | Covered |
| D24.1 | ICD10CM | Covered |
| D24.9 | ICD10CM | Covered |
| D48.60 | ICD10CM | Covered |
| D48.62 | ICD10CM | Covered |
| D49.3 | ICD10CM | Covered |
| D86.0 | ICD10CM | Covered |
| D86.89 | ICD10CM | Covered |
| E66.01 | ICD10CM | Covered |
| E67.8 | ICD10CM | Covered |
| F84.0 | ICD10CM | Covered |
| F84.9 | ICD10CM | Covered |
| G12.21 | ICD10CM | Covered |
| G47.33 | ICD10CM | Covered |
| G70.00 | ICD10CM | Covered |
| G70.9 | ICD10CM | Covered |
| J18.9 | ICD10CM | Covered |
| J41.0 | ICD10CM | Covered |
| J42 | ICD10CM | Covered |
| J43.0 | ICD10CM | Covered |
| J43.9 | ICD10CM | Covered |
| J44.0 | ICD10CM | Covered |
| J44.9 | ICD10CM | Covered |
| J45.20 | ICD10CM | Covered |
| J45.998 | ICD10CM | Covered |
| J84.89 | ICD10CM | Covered |
| K50.00 | ICD10CM | Covered |
| K50.919 | ICD10CM | Covered |
| K51.00 | ICD10CM | Covered |
| K51.919 | ICD10CM | Covered |
| K58.0 | ICD10CM | Covered |
| K58.9 | ICD10CM | Covered |
| K70.10 | ICD10CM | Covered |
| K70.11 | ICD10CM | Covered |
| K76.0 | ICD10CM | Covered |
| K90.0 | ICD10CM | Covered |
| M08.00 | ICD10CM | Covered |
| M08.99 | ICD10CM | Covered |
| N03.0 | ICD10CM | Covered |
| N05.9 | ICD10CM | Covered |
| N18.6 | ICD10CM | Covered |
| N39.0 | ICD10CM | Covered |
| N60.01 | ICD10CM | Covered |
| N65.1 | ICD10CM | Covered |
| P77.1 | ICD10CM | Covered |
| P77.9 | ICD10CM | Covered |
| T81. | ICD10CM | Covered |
| T86.810 | ICD10CM | Covered |
| T86.819 | ICD10CM | Covered |
| Z11.52 | ICD10CM | Covered |
| Z12.0 | ICD10CM | Covered |
| Z12.9 | ICD10CM | Covered |
| Z99.2 | ICD10CM | Covered |