Aetna · PayerPolicy · AETNA-CPB-0721
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 |
|---|---|---|
| 77424 | CPT | Covered |
| 77425 | CPT | Covered |
| 77469 | CPT | Covered |
| C00.0 | ICD10CM | Covered |
| C15.9 | ICD10CM | Covered |
| C16.0 | ICD10CM | Covered |
| C16.9 | ICD10CM | Covered |
| C18.0 | ICD10CM | Covered |
| C21.8 | ICD10CM | Covered |
| C22.0 | ICD10CM | Covered |
| C22.8 | ICD10CM | Covered |
| C25.0 | ICD10CM | Covered |
| C25.9 | ICD10CM | Covered |
| C30.0 | ICD10CM | Covered |
| C33 | ICD10CM | Covered |
| C37 | ICD10CM | Covered |
| C40.00 | ICD10CM | Covered |
| C41.9 | ICD10CM | Covered |
| C46.1 | ICD10CM | Covered |
| C49.0 | ICD10CM | Covered |
| C49.4 | ICD10CM | Covered |
| C49.5 | ICD10CM | Covered |
| C50.011 | ICD10CM | Covered |
| C50.929 | ICD10CM | Covered |
| C53.0 | ICD10CM | Covered |
| C54.9 | ICD10CM | Covered |
| C61 | ICD10CM | Covered |
| C64.1 | ICD10CM | Covered |
| C64.9 | ICD10CM | Covered |
| C69.00 | ICD10CM | Covered |
| C71.9 | ICD10CM | Covered |
| C72.20 | ICD10CM | Covered |
| C72.59 | ICD10CM | Covered |
| C73 | ICD10CM | Covered |
| C75.0 | ICD10CM | Covered |
| C75.4 | ICD10CM | Covered |
| C76.0 | ICD10CM | Covered |
| C79.31 | ICD10CM | Covered |
| C79.49 | ICD10CM | Covered |
| C79.52 | ICD10CM | Covered |
| D02.3 | ICD10CM | Covered |
| D05.00 | ICD10CM | Covered |
| D05.92 | ICD10CM | Covered |
| D17.71 | ICD10CM | Covered |