Comparative Genomic Hybridization (CGH) | Aetna | Backwork

Comparative Genomic Hybridization (CGH)

Aetna · PayerPolicy · AETNA-CPB-0787

Status: Active
Effective: October 11, 2023
Last reviewed by Aetna: November 19, 2025
Last checked by Backwork: October 1, 2026

Summary of the payer’s published policy. Not a coverage determination — confirm with Aetna before submitting.

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Codes in this policy

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.

Codes this policy lists and each code’s status in the policy
Code	Code system	Status in this policy
C43	ICD10CM	Covered
D03	ICD10CM	Covered
D89.82	ICD10CM	Covered
E28.310	ICD10CM	Covered
E28.39	ICD10CM	Covered
G40	ICD10CM	Covered
N96	ICD10CM	Covered
Q75.0	ICD10CM	Covered
R62.52	ICD10CM	Covered
Z13	ICD10CM	Covered