CPT 0628T · Intradiscal · Wellpoint of New Jersey — NJ Medicaid
ViaDisc — Lumbar (additional level) at Wellpoint of New Jersey — NJ Medicaid.
How Wellpoint of New Jersey — NJ Medicaid 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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Anthem Allograft Injection for DDD policy / SURG.00052 (related)Criteria summary
High-level themes from the Wellpoint of New Jersey — NJ Medicaid policy of record for CPT 0628T. Verbatim policy text and per-criterion analysis are available after sign-in.
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Source: Anthem Medical Policy — Allograft Injection for Degenerative Disc Disease
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