CPT 0628T · ViaDisc · Premera Blue Cross
ViaDisc — Lumbar (additional level) at Premera Blue Cross.
How Premera Blue Cross approaches CPT 0628T (ViaDisc — Lumbar (additional level)) for prior-authorization review: at last review on Date not on file, the policy does not cover this code with prior authorization required.
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TBDVerification pending. This record is awaiting confirmation against the latest policy document — criteria summary may not reflect the current revision.
Criteria summary
High-level themes from the Premera Blue Cross policy of record for CPT 0628T. Verbatim policy text and per-criterion analysis are available after sign-in.
Coverage criteria details available after sign-in.
Source: Premera — Cat III ViaDisc add-on
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