Aetna · PayerPolicy · AETNA-CPB-0767
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 |
|---|---|---|
| 92201 | CPT | Covered |
| 92202 | CPT | Covered |
| D18.09 | ICD10CM | Covered |
| D57.00 | ICD10CM | Covered |
| D57.1 | ICD10CM | Covered |
| D76.3 | ICD10CM | Covered |
| G10 | ICD10CM | Covered |
| G11.1 | ICD10CM | Covered |
| G12.0 | ICD10CM | Covered |
| G12.9 | ICD10CM | Covered |
| G20 | ICD10CM | Covered |
| G23.0 | ICD10CM | Covered |
| G23.9 | ICD10CM | Covered |
| G30.0 | ICD10CM | Covered |
| G30.9 | ICD10CM | Covered |
| G31.83 | ICD10CM | Covered |
| G93.2 | ICD10CM | Covered |
| H05.111 | ICD10CM | Covered |
| H05.119 | ICD10CM | Covered |
| H46.00 | ICD10CM | Covered |
| H46.9 | ICD10CM | Covered |
| Q13.0 | ICD10CM | Covered |
| Q87.1 | ICD10CM | Covered |
| Z08 | ICD10CM | Covered |
| Z12.89 | ICD10CM | Covered |
| Z13.5 | ICD10CM | Covered |
| Z51.81 | ICD10CM | Covered |
| Z85.820 | ICD10CM | Covered |