Aetna policies, page 110

Search Aetna's public medical, payment and drug policies by CPT or HCPCS code, keyword or policy number, with links to the payer's own documents. Links open the payer's own document; check its current version before relying on it.

5,481 public policies Substrate tracks for Aetna, by title.

Aetna policies
PolicyDetailsCodesSource
Voltaren Gel Limit Policy 1728-H 06-20231728-H · Commercial—Original policy ↗
Vonjo 5258-A SGM P20245258-A · Commercial—Original policy ↗
Vonjo 5258-A SGM P20245258-A · Commercial—Original policy ↗
Votrient 2009-A SGM P20232009-A · Commercial—Original policy ↗
Voxzogo SGM 5069-A P20265069-A · Commercial—Original policy ↗
VPRIV 2058-A SGM P20222058-A · Commercial—Original policy ↗
Vumerity 3395-A SGM P20233395-A · Commercial—Original policy ↗
Vyndaqel-Vyndamax SGM 3076-A P20253076-A · Commercial—Original policy ↗
Vytorin 10-80 Zocor 80 PA with Logic Policy 981-D 12-2022981-D · Commercial—Original policy ↗
Vyvanse ST, Post PA (Aetna SG ACA, IVL Only) Policy 3930-D 11-2020 v23930-D · Commercial—Original policy ↗
Wegovy (Cardiovascular) PA with Limit 6410-C UDR 03-20246410-C · Commercial—Original policy ↗
Wegovy PA with Limit 4774-C P08-2024_R4774-C · Commercial—Original policy ↗
Weight Reduction Programs and Devices0039 · Commercial46Original policy ↗
Wheelchairs and Power Operated Vehicles (Scooters)0271 · Commercial377Original policy ↗
Winlevi PA 4265-A P08-2024_R4265-A · Commercial—Original policy ↗
Work Hardening Programs0198 · Commercial4Original policy ↗
Wound Imaging and Noninvasive Wound Therapy0372 · Commercial10Original policy ↗
Xeloda 1993-A SGM P20221993-A · Commercial—Original policy ↗
Xermelo 1670-A SGM P20211670-A · Commercial—Original policy ↗
Xermelo SGM 1670-A P20261670-A · Commercial—Original policy ↗
Xiaflex 3043-A SGM P20203043-A · Commercial—Original policy ↗
Xifaxan 550 mg PA 681-A P04-2026681-A · Commercial—Original policy ↗
Xyrem PA with Limit Policy 254-C 04-2021254-C · Commercial—Original policy ↗
Xywav 4045-A SGM P20234045-A · Commercial—Original policy ↗
YAG Laser in Ophthalmology and Other Selected Indications0354 · Commercial26Original policy ↗
Ziconotide (Prialt)0712 · Commercial21Original policy ↗
Zofran, Zuplenz Limit Policy 259-H 01-2023259-H · Commercial—Original policy ↗
Zokinvy 4384-A SGM P20234384-A · Commercial—Original policy ↗
zoledronic acid-Reclast SGM 2380-A P20242380-A · Commercial—Original policy ↗
Zorbtive 2244-A SGM P20212244-A · Commercial—Original policy ↗
Zoryve PA with Limit 5537-C P07-2025 v35537-C · Commercial—Original policy ↗

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Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.