Aetna · PayerPolicy · AETNA-CPB-0735
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 |
|---|---|---|
| B02.21 | ICD10CM | Covered |
| B02.29 | ICD10CM | Covered |
| D21.0 | ICD10CM | Covered |
| D21.9 | ICD10CM | Covered |
| D36.10 | ICD10CM | Covered |
| D36.17 | ICD10CM | Covered |
| E08.40 | ICD10CM | Covered |
| E08.49 | ICD10CM | Covered |
| E09.40 | ICD10CM | Covered |
| E09.49 | ICD10CM | Covered |
| E10.40 | ICD10CM | Covered |
| E10.49 | ICD10CM | Covered |
| E11.40 | ICD10CM | Covered |
| E11.49 | ICD10CM | Covered |
| E13.40 | ICD10CM | Covered |
| E13.49 | ICD10CM | Covered |
| F52.4 | ICD10CM | Covered |
| G09.01 | ICD10CM | Covered |
| G09.09 | ICD10CM | Covered |
| G44.1 | ICD10CM | Covered |
| G50.0 | ICD10CM | Covered |
| G52.1 | ICD10CM | Covered |
| G56.00 | ICD10CM | Covered |
| G56.03 | ICD10CM | Covered |
| G57.0 | ICD10CM | Covered |
| G57.93 | ICD10CM | Covered |
| G58.0 | ICD10CM | Covered |
| G58.8 | ICD10CM | Covered |
| G58.9 | ICD10CM | Covered |
| G60.3 | ICD10CM | Covered |
| G60.8 | ICD10CM | Covered |
| G60.9 | ICD10CM | Covered |
| G81.0 | ICD10CM | Covered |
| G81.94 | ICD10CM | Covered |
| G89.21 | ICD10CM | Covered |
| G89.28 | ICD10CM | Covered |
| G89.3 | ICD10CM | Covered |
| G90.50 | ICD10CM | Covered |
| G90.59 | ICD10CM | Covered |
| H93.11 | ICD10CM | Covered |
| H93.19 | ICD10CM | Covered |
| L74.510 | ICD10CM | Covered |
| L74.9 | ICD10CM | Covered |
| L90.6 | ICD10CM | Covered |
| M12.9 | ICD10CM | Covered |
| M17.0 | ICD10CM | Covered |
| M17.9 | ICD10CM | Covered |
| M25.50 | ICD10CM | Covered |
| M25.579 | ICD10CM | Covered |
| M51.15 | ICD10CM | Covered |
| M51.17 | ICD10CM | Covered |
| M51.26 | ICD10CM | Covered |
| M51.9 | ICD10CM | Covered |
| M53.3 | ICD10CM | Covered |
| M54.10 | ICD10CM | Covered |
| M54.12 | ICD10CM | Covered |
| M54.17 | ICD10CM | Covered |
| M54.18 | ICD10CM | Covered |
| M54.2 | ICD10CM | Covered |
| M54.50 | ICD10CM | Covered |
| M54.59 | ICD10CM | Covered |
| M54.6 | ICD10CM | Covered |
| M54.81 | ICD10CM | Covered |
| M54.89 | ICD10CM | Covered |
| M54.9 | ICD10CM | Covered |
| M72.2 | ICD10CM | Covered |
| M75.00 | ICD10CM | Covered |
| M75.02 | ICD10CM | Covered |
| M77.40 | ICD10CM | Covered |
| M77.42 | ICD10CM | Covered |
| M78.18 | ICD10CM | Covered |
| M79.10 | ICD10CM | Covered |
| M79.2 | ICD10CM | Covered |
| M79.601 | ICD10CM | Covered |
| M79.676 | ICD10CM | Covered |
| N50.811 | ICD10CM | Covered |
| N50.819 | ICD10CM | Covered |
| N94.2 | ICD10CM | Covered |
| N94.810 | ICD10CM | Covered |
| N94.819 | ICD10CM | Covered |
| R10.2 | ICD10CM | Covered |
| R39.11 | ICD10CM | Covered |
| R39.15 | ICD10CM | Covered |
| R51 | ICD10CM | Covered |
| R52 | ICD10CM | Covered |
| Z89.01 | ICD10CM | Covered |
| Z89.9 | ICD10CM | Covered |