Z68 with Aetna: what the policy says
The short answerYes, for most ranges. Aetna's CPB 0049 lists Z68.30 to Z68.45 and the pediatric codes Z68.53 and Z68.54. Z68.25 to Z68.29 (adult BMI 25.0 to 29.9) counts only with a cardiovascular risk factor.
By Javier Alvarez · Updated · 1 min read
1 row: Aetna. Public policy, not the member's benefits.
Aetna
Commercial · All states
| 97802 | Listed [1] |
|---|---|
| 97803 | Listed [1] |
| G0270 | Listed [1] |
| G0271 | Listed [1] |
| Diagnoses | E66.x obesity; E66.3 overweight and Z68.25 to Z68.29 only with a cardiovascular risk factor; Z68.30 to Z68.45; F50.x eating disorders. Diabetes, kidney disease, hypertension and GI disorders are named as covered conditions. Z71.3 is not in the coding section. [1] |
| Other codes | 97804, G0447, G0473 and S9470; 99401 to 99412 as related codes. [1] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | Weight-reduction counseling for adults with a BMI of 30 or more: up to 26 individual or group visits per 12 months, combined across providers. No general MNT visit limit in the policy; other limits are set by the plan. [2] |
| Referral and prior auth | "Some plans require referrals." The policy states no prior authorization. [1] |
- Aetna: Clinical Policy Bulletin 0049, Nutritional Counseling (page as shown 2026-10-30), checked October 30, 2026
- Aetna: Clinical Policy Bulletin 0039, Weight Reduction Medications and Programs, checked October 22, 2026
What Aetna's policy says about Z68
Z68 is the ICD-10-CM code for body mass index [BMI]. At Aetna it is listed: named in the payer's public policy. Each line below is from Aetna's own text:
- Where it is listed. Adult Z68.30 to Z68.45 is listed on its own, with no extra risk factor needed. (Aetna, checked October 30, 2026)
- Billed with. Pediatric codes are listed too: Z68.53 (85th percentile to under the 95th for age) and Z68.54 (95th percentile or higher). (Aetna, checked October 30, 2026)
- When it pays. Z68.25 to Z68.29 is covered only for adults who also have a cardiovascular risk factor: hypertension, dyslipidemia, impaired fasting glucose or the metabolic syndrome. (Aetna, checked October 30, 2026)
Z68 at other payers
- Z68 with Blue Cross NC: limited.
- Z68 with Blue Cross and Blue Shield of Alabama: listed.
- Z68 with UnitedHealthcare: listed.
- Z68 with Anthem Blue Cross and Blue Shield: listed.
- Z68 with Medicare: limited.
The rest of Aetna's MNT rules
The Aetna row has its codes, telehealth rule, limits and referrals, each with its source. Other codes we checked at Aetna: E66. What Z68 means at any payer is on the Z68 code page. Before the claim goes out, compare it with the row in the table above, then download the PDF of what you see.