CPT 0628T · Intradiscal · Priority Partners MCO
ViaDisc — Lumbar (additional level) at Priority Partners MCO.
How Priority Partners MCO approaches CPT 0628T (ViaDisc — Lumbar (additional level)) for prior-authorization review: at last review on 2026-04-27, the policy does not cover this code with prior authorization required.
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Criteria summary
High-level themes from the Priority Partners MCO 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: Priority Partners (JHHC) — Maryland Medicaid (Category III CPT, no specific medical policy)
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