Aetna policy
0972-Mitomycin Pyelocalyceal Solution (Jelmyto)
0972-Mitomycin Pyelocalyceal Solution (Jelmyto) is a public Aetna policy (policy 0972). It lists 4 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.
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- Payer
- Aetna
- Policy number
- 0972
- Line of business
- Commercial
- Source
- www.aetna.com
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes. Open official prior authorization lists to check the member’s product.
| Code | Other Aetna policies |
|---|---|
| 50391 | Policies naming 50391 |
| 52005 | Policies naming 52005 |
| C9789 | Policies naming C9789 |
| J9281 | Policies naming J9281 |