CPT 0627T · Intradiscal · Ohio Medicaid
ViaDisc / Disc Allograft — Lumbar (1st level) at Ohio Medicaid.
How Ohio Medicaid approaches CPT 0627T (ViaDisc / Disc Allograft — Lumbar (1st level)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-05-06
Criteria summary
High-level themes from the Ohio Medicaid policy of record for CPT 0627T. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 8 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Ohio Medicaid Interventional Pain Management Coverage Guidelines
See the full Ohio Medicaid criteria.
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