Aetna · PayerPolicy · AETNA-CPB-0763
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 |
|---|---|---|
| 83090 | CPT | Covered |
| A1298C | HCPCS | Covered |
| A1298C | ICD10CM | Covered |
| B12 | ICD10CM | Covered |
| C16.0 | ICD10CM | Covered |
| C16.9 | ICD10CM | Covered |
| C677T | ICD10CM | Covered |
| D51.0 | ICD10CM | Covered |
| D51.9 | ICD10CM | Covered |
| D68.51 | ICD10CM | Covered |
| D68.69 | ICD10CM | Covered |
| D81.818 | ICD10CM | Covered |
| D81.819 | ICD10CM | Covered |
| E10.10 | ICD10CM | Covered |
| E13.9 | ICD10CM | Covered |
| E28.2 | ICD10CM | Covered |
| E28.310 | ICD10CM | Covered |
| E28.319 | ICD10CM | Covered |
| E53.8 | ICD10CM | Covered |
| E71.41 | ICD10CM | Covered |
| E72.10 | ICD10CM | Covered |
| E72.11 | ICD10CM | Covered |
| E72.19 | ICD10CM | Covered |
| E75.00 | ICD10CM | Covered |
| E75.19 | ICD10CM | Covered |
| E75.22 | ICD10CM | Covered |
| E75.23 | ICD10CM | Covered |
| E75.25 | ICD10CM | Covered |
| E75.29 | ICD10CM | Covered |
| E75.4 | ICD10CM | Covered |
| E75.6 | ICD10CM | Covered |
| E78.00 | ICD10CM | Covered |
| E78.01 | ICD10CM | Covered |
| E78.6 | ICD10CM | Covered |
| F01.50 | ICD10CM | Covered |
| F99 | ICD10CM | Covered |
| G10 | ICD10CM | Covered |
| G11.0 | ICD10CM | Covered |
| G11.9 | ICD10CM | Covered |
| G12.0 | ICD10CM | Covered |
| G12.9 | ICD10CM | Covered |
| G13.2 | ICD10CM | Covered |
| G13.8 | ICD10CM | Covered |
| G20 | ICD10CM | Covered |
| G21.9 | ICD10CM | Covered |
| G23.0 | ICD10CM | Covered |
| G23.9 | ICD10CM | Covered |
| G24.01 | ICD10CM | Covered |
| G24.9 | ICD10CM | Covered |
| G25.0 | ICD10CM | Covered |
| G26 | ICD10CM | Covered |
| G30.0 | ICD10CM | Covered |
| G30.9 | ICD10CM | Covered |
| G31.01 | ICD10CM | Covered |
| G31.09 | ICD10CM | Covered |
| G31.1 | ICD10CM | Covered |
| G31.2 | ICD10CM | Covered |
| G31.81 | ICD10CM | Covered |
| G31.9 | ICD10CM | Covered |
| G32.0 | ICD10CM | Covered |
| G32.81 | ICD10CM | Covered |
| G35 | ICD10CM | Covered |
| G43.001 | ICD10CM | Covered |
| G43.919 | ICD10CM | Covered |
| G80.3 | ICD10CM | Covered |
| G80.9 | ICD10CM | Covered |
| G89.0 | ICD10CM | Covered |
| G89.4 | ICD10CM | Covered |
| G90.01 | ICD10CM | Covered |
| G90.09 | ICD10CM | Covered |
| G90.2 | ICD10CM | Covered |
| G90.3 | ICD10CM | Covered |
| G90.4 | ICD10CM | Covered |
| G90.50 | ICD10CM | Covered |
| G90.59 | ICD10CM | Covered |
| G90.8 | ICD10CM | Covered |
| G90.9 | ICD10CM | Covered |
| G91.0 | ICD10CM | Covered |
| G91.9 | ICD10CM | Covered |
| G93.7 | ICD10CM | Covered |
| G93.89 | ICD10CM | Covered |
| G93.9 | ICD10CM | Covered |
| G94 | ICD10CM | Covered |
| G95.0 | ICD10CM | Covered |
| G95.9 | ICD10CM | Covered |
| G99.0 | ICD10CM | Covered |
| G99.2 | ICD10CM | Covered |
| H34.00 | ICD10CM | Covered |
| H34.03 | ICD10CM | Covered |
| H34.211 | ICD10CM | Covered |
| H34.8110 | ICD10CM | Covered |
| H34.8192 | ICD10CM | Covered |
| H34.9 | ICD10CM | Covered |
| H35.30 | ICD10CM | Covered |
| H35.3293 | ICD10CM | Covered |
| H81.01 | ICD10CM | Covered |
| H81.09 | ICD10CM | Covered |
| K50.00 | ICD10CM | Covered |
| K50.919 | ICD10CM | Covered |
| K51.90 | ICD10CM | Covered |
| K51.919 | ICD10CM | Covered |
| K52.0 | ICD10CM | Covered |
| K52.9 | ICD10CM | Covered |
| K90.0 | ICD10CM | Covered |
| N46.01 | ICD10CM | Covered |
| N46.9 | ICD10CM | Covered |
| N52.01 | ICD10CM | Covered |
| N52.9 | ICD10CM | Covered |
| N96 | ICD10CM | Covered |
| N97.0 | ICD10CM | Covered |
| N97.9 | ICD10CM | Covered |
| P91.821 | ICD10CM | Covered |
| P91.829 | ICD10CM | Covered |
| Q28.0 | ICD10CM | Covered |
| Q90.0 | ICD10CM | Covered |
| Q90.9 | ICD10CM | Covered |
| R52 | ICD10CM | Covered |
| Z13.6 | ICD10CM | Covered |
| Z31.441 | ICD10CM | Covered |
| Z51.81 | ICD10CM | Covered |
| Z76.82 | ICD10CM | Covered |
| Z79.899 | ICD10CM | Covered |
| Z82.49 | ICD10CM | Covered |