CPT 62330 · Decompression · Molina Healthcare of Florida
MILD — Percutaneous Lumbar Decompression (no image guidance) at Molina Healthcare of Florida.
How Molina Healthcare of Florida approaches CPT 62330 (MILD — Percutaneous Lumbar Decompression (no image guidance)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-05-06
Policy number
Molina FL — CMS NCD 150.13 (MILD)Criteria summary
High-level themes from the Molina Healthcare of Florida policy of record for CPT 62330. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 26 weeks of conservative care typically required.
- Imaging concordance documentation required.
See the full Molina Healthcare of Florida criteria.
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