CPT 62330 · Decompression · Pennsylvania Medical Assistance
MILD — Percutaneous Lumbar Decompression (no image guidance) at Pennsylvania Medical Assistance.
How Pennsylvania Medical Assistance 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
Criteria summary
High-level themes from the Pennsylvania Medical Assistance policy of record for CPT 62330. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 6 weeks of conservative care typically required.
- Imaging concordance documentation required.
See the full Pennsylvania Medical Assistance criteria.
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