Rubrica

CPT 0627T · Intradiscal · Molina Healthcare of Florida

ViaDisc / Disc Allograft — Lumbar (1st level) at Molina Healthcare of Florida.

How Molina Healthcare of Florida 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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Coverage Not covered
Prior auth Prior auth required
InvestigationalInvestigational / experimental
Last reviewed 2026-05-06
Policy numberMolina MCP — Intradiscal Procedures

Criteria summary

High-level themes from the Molina Healthcare of Florida 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: Molina Clinical Policy — Intradiscal Procedures (Disc Allograft / ViaDisc) (adopted by Molina Healthcare of Florida Medicaid)

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