Aetna · PayerPolicy · AETNA-CPB-0748
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 |
|---|---|---|
| 81210 | CPT | Covered |
| 81275 | CPT | Covered |
| 81276 | CPT | Covered |
| 81311 | CPT | Covered |
| 81404 | CPT | Covered |
| 88363 | CPT | Covered |
| 96365 | CPT | Covered |
| 96368 | CPT | Covered |
| 96413 | CPT | Covered |
| 96417 | CPT | Covered |
| J9303 | HCPCS | Covered |
| C15.3 | ICD10CM | Covered |
| C15.9 | ICD10CM | Covered |
| C16.0 | ICD10CM | Covered |
| C16.9 | ICD10CM | Covered |
| C18.0 | ICD10CM | Covered |
| C18.9 | ICD10CM | Covered |
| C19 | ICD10CM | Covered |
| C21.8 | ICD10CM | Covered |
| C22.1 | ICD10CM | Covered |
| C23 | ICD10CM | Covered |
| C24.0 | ICD10CM | Covered |
| C25.0 | ICD10CM | Covered |
| C25.9 | ICD10CM | Covered |
| C34.00 | ICD10CM | Covered |
| C34.92 | ICD10CM | Covered |
| C41.0 | ICD10CM | Covered |
| C41.9 | ICD10CM | Covered |
| C49. | ICD10CM | Covered |
| C49.0 | ICD10CM | Covered |
| C50.011 | ICD10CM | Covered |
| C50.929 | ICD10CM | Covered |
| C56.1 | ICD10CM | Covered |
| C56.9 | ICD10CM | Covered |
| C60.0 | ICD10CM | Covered |
| C60.9 | ICD10CM | Covered |
| C64.0 | ICD10CM | Covered |
| C64.9 | ICD10CM | Covered |
| C67.0 | ICD10CM | Covered |
| C67.5 | ICD10CM | Covered |
| C70.0 | ICD10CM | Covered |
| C72.9 | ICD10CM | Covered |
| C76.0 | ICD10CM | Covered |
| C79.00 | ICD10CM | Covered |
| C79.02 | ICD10CM | Covered |
| G12C | ICD10CM | Covered |
| K80.50 | ICD10CM | Covered |
| K80.51 | ICD10CM | Covered |
| V600 | ICD10CM | Covered |
| V600E | ICD10CM | Covered |