Rubrica

CPT 0275T · Decompression · AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices

MILD — Percutaneous Image-Guided Lumbar Decompression (DELETED 2026) at AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices.

How AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices approaches CPT 0275T (MILD — Percutaneous Image-Guided Lumbar Decompression (DELETED 2026)) for prior-authorization review: at last review on 2026-05-06, the policy does not cover this code with prior authorization required.

Free with practitioner sign-in — magic-link email auth, no credit card.

Coverage Not covered
Prior auth Prior auth required
InvestigationalInvestigational / experimental
Last reviewed 2026-05-06
Policy numbereviCore CMM-608

Criteria summary

High-level themes from the AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices policy of record for CPT 0275T. Verbatim policy text and per-criterion analysis are available after sign-in.

Coverage criteria details available after sign-in.

Source: eviCore CMM-608 — MILD Percutaneous Lumbar Decompression (EIU; AC Family / Keystone First) [DELETED CODE]

See the full AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices criteria.

Sign in for verbatim conservative-care language, exact imaging-concordance rules, repeat-procedure thresholds, and the denial-risk score for any specific clinical scenario.

Sign in — free for practitioners →