CPT 0275T · Decompression · Health Partners Plans / Jefferson Health Plans — PA HealthChoices
MILD — Percutaneous Image-Guided Lumbar Decompression (DELETED 2026) at Health Partners Plans / Jefferson Health Plans — PA HealthChoices.
How Health Partners Plans / Jefferson Health Plans — 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.
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Criteria summary
High-level themes from the Health Partners Plans / Jefferson Health Plans — 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: PA Medical Assistance (FFS) — Cat III code deleted by CMS/CPT; deferred from HPP/Jefferson
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