CPT 0627T · Intradiscal · AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices
ViaDisc / Disc Allograft — Lumbar (1st level) at AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices.
How AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices approaches CPT 0627T (ViaDisc / Disc Allograft — Lumbar (1st level)) 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 AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices policy of record for CPT 0627T. Verbatim policy text and per-criterion analysis are available after sign-in.
Coverage criteria details available after sign-in.
Source: eviCore — ViaDisc / Disc Allograft (EIU; AC Family / Keystone First)
See the full AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices criteria.
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