Does D57.00 require prior authorization?

No, D57.00 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D57.00` — Hb-SS disease with crisis, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims should reference and be supported by LCD L34580 and follow the billing/coding guidelines in this article; specific documentation requirements (e.g., medical records, prior authorization) are those detailed in LCD L34580.
Claims must include the documentation and coding required by LCD L34426 and applicable billing/coding guidelines (procedure codes, supporting clinical rationale, and any required authorizations), as this article supplements that LCD.
Select and report the appropriate CPT or PLA code for the blood product molecular antigen typing service and enter the unit of service (UOS) on the claim.
For Part B claims, enter the appropriate DEX Z-Code identifier adjacent to the CPT/PLA code in the comment/narrative field: use Loop 2400 or SV101-7 for 5010A1 837P electronic claims or Box 19 for paper claims.

Billing and coding for intravenous immunoglobulin (IVIG) should follow the Local Coverage Determination (LCD) L34580 and the billing/coding guidelines in this article as a complement to that LCD.
Coverage for ophthalmic angiography (fluorescein and indocyanine green) is determined by the Local Coverage Determination L34426 and applies when that LCD's clinical criteria are met.
MolDX blood product molecular antigen typing panels 0001U and 0084U (germline tests) are covered for beneficiaries but are limited to one test per beneficiary lifetime.
Taped and un-taped visual field testing count as one unit of service for MUE (medically unlikely edits) purposes.
Global visual field services (technical plus professional) are payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), and Independent Clinic (49).
The technical component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Nursing Facility (32), Independent Clinic (49), Federally Qualified Health Center (50), and Rural Health Clinic (72).

A57592 — Billing and Coding: Non-Invasive Cerebrovascular Studies

J05

L34615 — Visual Fields

J05

A57483 — Billing and Coding: Visual Fields

J05

L35753 — Non-Invasive Cerebrovascular Studies

J05

A57110 — Billing and Coding: MolDX: Blood Product Molecular Antigen Typing

Ask Verity about documentation requirements, denial risks, or coverage in your state.