Aetna · PayerPolicy · AETNA-CPB-0719
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 |
|---|---|---|
| 65770 | CPT | Covered |
| 67027 | CPT | Covered |
| 67028 | CPT | Covered |
| C1814 | HCPCS | Covered |
| J7311 | HCPCS | Covered |
| J7313 | HCPCS | Covered |
| J7314 | HCPCS | Covered |
| A52.71 | ICD10CM | Covered |
| A54.30 | ICD10CM | Covered |
| A54.39 | ICD10CM | Covered |
| A71.0 | ICD10CM | Covered |
| A71.9 | ICD10CM | Covered |
| B02.30 | ICD10CM | Covered |
| B02.39 | ICD10CM | Covered |
| B30.0 | ICD10CM | Covered |
| B30.9 | ICD10CM | Covered |
| C69.20 | ICD10CM | Covered |
| C69.22 | ICD10CM | Covered |
| D48.7 | ICD10CM | Covered |
| E08.311 | ICD10CM | Covered |
| E08.3211 | ICD10CM | Covered |
| E08.3219 | ICD10CM | Covered |
| E08.3311 | ICD10CM | Covered |
| E08.3319 | ICD10CM | Covered |
| E08.41 | ICD10CM | Covered |
| E08.51 | ICD10CM | Covered |
| E09.311 | ICD10CM | Covered |
| E09.3211 | ICD10CM | Covered |
| E09.3219 | ICD10CM | Covered |
| E09.3311 | ICD10CM | Covered |
| E09.3312 | ICD10CM | Covered |
| E09.3411 | ICD10CM | Covered |
| E09.3419 | ICD10CM | Covered |
| E09.3511 | ICD10CM | Covered |
| E09.3559 | ICD10CM | Covered |
| E10.311 | ICD10CM | Covered |
| E10.3211 | ICD10CM | Covered |
| E10.3219 | ICD10CM | Covered |
| E10.3311 | ICD10CM | Covered |
| E10.3319 | ICD10CM | Covered |
| E10.3411 | ICD10CM | Covered |
| E10.3419 | ICD10CM | Covered |
| E10.3511 | ICD10CM | Covered |
| E10.3559 | ICD10CM | Covered |
| E11.311 | ICD10CM | Covered |
| E11.3211 | ICD10CM | Covered |
| E11.3219 | ICD10CM | Covered |
| E11.3311 | ICD10CM | Covered |
| E11.3319 | ICD10CM | Covered |
| E11.3411 | ICD10CM | Covered |
| E11.3419 | ICD10CM | Covered |
| E11.3511 | ICD10CM | Covered |
| E11.3559 | ICD10CM | Covered |
| E13.11 | ICD10CM | Covered |
| E13.3211 | ICD10CM | Covered |
| E13.3219 | ICD10CM | Covered |
| E13.3311 | ICD10CM | Covered |
| E13.3319 | ICD10CM | Covered |
| E13.3411 | ICD10CM | Covered |
| E13.3419 | ICD10CM | Covered |
| E13.3511 | ICD10CM | Covered |
| E13.3559 | ICD10CM | Covered |
| H00.011 | ICD10CM | Covered |
| H00.19 | ICD10CM | Covered |
| H01.001 | ICD10CM | Covered |
| H01.029 | ICD10CM | Covered |
| H04.001 | ICD10CM | Covered |
| H04.039 | ICD10CM | Covered |
| H04.301 | ICD10CM | Covered |
| H04.339 | ICD10CM | Covered |
| H04.411 | ICD10CM | Covered |
| H04.439 | ICD10CM | Covered |
| H05.00 | ICD10CM | Covered |
| H05.049 | ICD10CM | Covered |
| H10.011 | ICD10CM | Covered |
| H10.9 | ICD10CM | Covered |
| H15.001 | ICD10CM | Covered |
| H15.009 | ICD10CM | Covered |
| H15.101 | ICD10CM | Covered |
| H15.129 | ICD10CM | Covered |
| H16.001 | ICD10CM | Covered |
| H16.9 | ICD10CM | Covered |
| H30.001 | ICD10CM | Covered |
| H30.049 | ICD10CM | Covered |
| H30.101 | ICD10CM | Covered |
| H30.139 | ICD10CM | Covered |
| H30.90 | ICD10CM | Covered |
| H30.93 | ICD10CM | Covered |
| H40.001 | ICD10CM | Covered |
| H40.9 | ICD10CM | Covered |
| H44.001 | ICD10CM | Covered |
| H44.029 | ICD10CM | Covered |
| H44.111 | ICD10CM | Covered |
| H44.129 | ICD10CM | Covered |
| H44.19 | ICD10CM | Covered |
| H59.40 | ICD10CM | Covered |
| H59.43 | ICD10CM | Covered |