CPT 0628T · Intradiscal · UPMC for You — PA HealthChoices
ViaDisc — Lumbar (additional level) at UPMC for You — PA HealthChoices.
How UPMC for You — PA HealthChoices approaches CPT 0628T (ViaDisc — Lumbar (additional 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 UPMC for You — PA HealthChoices 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.
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