Aetna · PayerPolicy · AETNA-CPB-0783
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 |
|---|---|---|
| 43206 | CPT | Covered |
| 43252 | CPT | Covered |
| 45378 | CPT | Covered |
| G0105 | HCPCS | Covered |
| G0121 | HCPCS | Covered |
| B65.0 | ICD10CM | Covered |
| C15.3 | ICD10CM | Covered |
| C26.9 | ICD10CM | Covered |
| C34.00 | ICD10CM | Covered |
| C34.92 | ICD10CM | Covered |
| C44.42 | ICD10CM | Covered |
| C56.1 | ICD10CM | Covered |
| C56.9 | ICD10CM | Covered |
| C61 | ICD10CM | Covered |
| C67.0 | ICD10CM | Covered |
| C67.9 | ICD10CM | Covered |
| C71.0 | ICD10CM | Covered |
| C71.9 | ICD10CM | Covered |
| C72.0 | ICD10CM | Covered |
| C72.9 | ICD10CM | Covered |
| D13.5 | ICD10CM | Covered |
| J38.00 | ICD10CM | Covered |
| J38.7 | ICD10CM | Covered |
| J84.89 | ICD10CM | Covered |
| K21.00 | ICD10CM | Covered |
| K21.9 | ICD10CM | Covered |
| K22.710 | ICD10CM | Covered |
| K30 | ICD10CM | Covered |
| K50.00 | ICD10CM | Covered |
| K50.919 | ICD10CM | Covered |
| K51.00 | ICD10CM | Covered |
| K51.919 | ICD10CM | Covered |
| K58.0 | ICD10CM | Covered |
| K58.9 | ICD10CM | Covered |
| K63.5 | ICD10CM | Covered |
| K83.01 | ICD10CM | Covered |
| K83.9 | ICD10CM | Covered |
| K86.2 | ICD10CM | Covered |
| K86.89 | ICD10CM | Covered |
| Q43.1 | ICD10CM | Covered |
| T86.810 | ICD10CM | Covered |
| Z12.11 | ICD10CM | Covered |
| Z12.89 | ICD10CM | Covered |
| Z86.010 | ICD10CM | Covered |