Rubrica

CPT 0629T · Intradiscal · Highmark Wholecare — PA HealthChoices

ViaDisc / Disc Allograft — Cervical/Thoracic (1st level) at Highmark Wholecare — PA HealthChoices.

How Highmark Wholecare — PA HealthChoices approaches CPT 0629T (ViaDisc / Disc Allograft — Cervical/Thoracic (1st 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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Coverage Not covered
Prior auth Prior auth required
InvestigationalInvestigational / experimental
Last reviewed 2026-05-06
Policy numberHealthHelp IPM — Disc Allograft (Non-Covered)

Criteria summary

High-level themes from the Highmark Wholecare — PA HealthChoices policy of record for CPT 0629T. Verbatim policy text and per-criterion analysis are available after sign-in.

Coverage criteria details available after sign-in.

Source: Highmark Wholecare PA Medicaid Prior Authorization List (eff 05/01/2026) — HealthHelp delegated for MSK / IPM

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