Aetna · PayerPolicy · AETNA-CPB-0780
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 |
|---|---|---|
| 85397 | CPT | Covered |
| A41.9 | ICD10CM | Covered |
| B18.0 | ICD10CM | Covered |
| B18.1 | ICD10CM | Covered |
| C18.0 | ICD10CM | Covered |
| C20 | ICD10CM | Covered |
| C22.0 | ICD10CM | Covered |
| C43.0 | ICD10CM | Covered |
| C43.9 | ICD10CM | Covered |
| C92.10 | ICD10CM | Covered |
| C92.92 | ICD10CM | Covered |
| D59.3 | ICD10CM | Covered |
| D59.39 | ICD10CM | Covered |
| D68.01 | ICD10CM | Covered |
| E08.311 | ICD10CM | Covered |
| E08.3599 | ICD10CM | Covered |
| E09.311 | ICD10CM | Covered |
| E09.3599 | ICD10CM | Covered |
| E10.311 | ICD10CM | Covered |
| E10.3599 | ICD10CM | Covered |
| E11.311 | ICD10CM | Covered |
| E11.3599 | ICD10CM | Covered |
| E13.311 | ICD10CM | Covered |
| E13.3599 | ICD10CM | Covered |
| G47.33 | ICD10CM | Covered |
| J96.00 | ICD10CM | Covered |
| J96.92 | ICD10CM | Covered |
| K50.00 | ICD10CM | Covered |
| K50.919 | ICD10CM | Covered |
| K51.00 | ICD10CM | Covered |
| K51.919 | ICD10CM | Covered |
| K70.0 | ICD10CM | Covered |
| K76.6 | ICD10CM | Covered |
| K77 | ICD10CM | Covered |
| K83.01 | ICD10CM | Covered |
| K83.09 | ICD10CM | Covered |
| K85.00 | ICD10CM | Covered |
| K85.92 | ICD10CM | Covered |
| M31.1 | ICD10CM | Covered |
| M31.10 | ICD10CM | Covered |
| M31.11 | ICD10CM | Covered |
| M31.19 | ICD10CM | Covered |
| M32.10 | ICD10CM | Covered |
| M32.9 | ICD10CM | Covered |
| N17.9 | ICD10CM | Covered |
| N80. | ICD10CM | Covered |
| N80.00 | ICD10CM | Covered |
| Q24.9 | ICD10CM | Covered |
| R65.10 | ICD10CM | Covered |
| R65.21 | ICD10CM | Covered |
| S06. | ICD10CM | Covered |
| Z94.0 | ICD10CM | Covered |
| Z94.84 | ICD10CM | Covered |
| Z98.89 | ICD10CM | Covered |