Aetna · PayerPolicy · AETNA-CPB-0765
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 |
|---|---|---|
| 67028 | CPT | Covered |
| 67221 | CPT | Covered |
| 67225 | CPT | Covered |
| 83090 | CPT | Covered |
| 95930 | CPT | Covered |
| C9161 | HCPCS | Covered |
| C9257 | HCPCS | Covered |
| J0178 | HCPCS | Covered |
| J2503 | HCPCS | Covered |
| J2778 | HCPCS | Covered |
| J3396 | HCPCS | Covered |
| J9035 | HCPCS | Covered |
| Q5107 | HCPCS | Covered |
| C9161 | ICD10CM | Covered |
| H35. | ICD10CM | Covered |
| H35.051 | ICD10CM | Covered |
| H35.059 | ICD10CM | Covered |
| H35.30 | ICD10CM | Covered |
| H35.31 | ICD10CM | Covered |
| H35.3110 | ICD10CM | Covered |
| H35.3194 | ICD10CM | Covered |
| H35.32 | ICD10CM | Covered |
| H35.3210 | ICD10CM | Covered |
| H35.3293 | ICD10CM | Covered |
| H53.413 | ICD10CM | Covered |
| Y402H | ICD10CM | Covered |