Aetna · PayerPolicy · AETNA-CPB-0734
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 |
|---|---|---|
| 92285 | CPT | Covered |
| C31.0 | ICD10CM | Covered |
| C31.9 | ICD10CM | Covered |
| C78.39 | ICD10CM | Covered |
| D02.3 | ICD10CM | Covered |
| D14.0 | ICD10CM | Covered |
| D38.5 | ICD10CM | Covered |
| D49.1 | ICD10CM | Covered |
| F79 | ICD10CM | Covered |
| H02.051 | ICD10CM | Covered |
| H02.059 | ICD10CM | Covered |
| H04.001 | ICD10CM | Covered |
| H04.029 | ICD10CM | Covered |
| H05.421 | ICD10CM | Covered |
| H05.429 | ICD10CM | Covered |
| H10.821 | ICD10CM | Covered |
| H10.829 | ICD10CM | Covered |
| H11.151 | ICD10CM | Covered |
| H11.159 | ICD10CM | Covered |
| H11.30 | ICD10CM | Covered |
| H11.33 | ICD10CM | Covered |
| H15.011 | ICD10CM | Covered |
| H15.019 | ICD10CM | Covered |
| H15.101 | ICD10CM | Covered |
| H15.129 | ICD10CM | Covered |
| H16.221 | ICD10CM | Covered |
| H16.229 | ICD10CM | Covered |
| H50.10 | ICD10CM | Covered |
| H50.18 | ICD10CM | Covered |
| Q10.3 | ICD10CM | Covered |
| S02. | ICD10CM | Covered |
| S02.831A | ICD10CM | Covered |
| S02.839S | ICD10CM | Covered |
| S02.841A | ICD10CM | Covered |
| S02.849S | ICD10CM | Covered |