Rubrica

CPT 0629T · Intradiscal · UPMC for You — PA HealthChoices

ViaDisc / Disc Allograft — Cervical/Thoracic (1st level) at UPMC for You — PA HealthChoices.

How UPMC for You — 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

Criteria summary

High-level themes from the UPMC for You — 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: UPMC Health Plan Policies & Procedures Manual + InterQual criteria sets (e.g., CRM.003 Interventional Pain) — UPMC for You in-house UM

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