Does D57.214 require prior authorization?

No, D57.214 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D57.214` — Sickle-cell/Hb-C disease with dactylitis

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
Claims must follow the complementary Local Coverage Determination (LCD L34430) and, when CPT 97000–97799 are used by PT/OT, must include documentation that the services meet the coverage and documentation requirements for physical or occupational therapy.
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.

Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
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.
Fluorescein angiography is covered when the medical record documents medical necessity for the procedure for each eye, including relevant history, physical exam, and results of pertinent diagnostic tests.
Indocyanine green (ICG) angiography is covered when one or more of the following are documented: (1) ill-defined subretinal neovascular membrane or suspicious membrane on prior fluorescein angiography, (2) retinal pigment epithelium (RPE) does not show subretinal neovascular membrane on current fluorescein angiography, or (3) presence of subretinal hemorrhage or hemorrhagic RPE.
Diagnostic angiography (fluorescein or ICG) is covered when the claim includes a valid ICD-10-CM diagnosis code that best describes the patient's condition or the symptom prompting the test, and the ordering/referring provider's name and NPI are reported when required.

L35753 — Non-Invasive Cerebrovascular Studies

J05

A57592 — Billing and Coding: Non-Invasive Cerebrovascular Studies

J05

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

J05

L38441 — MolDX: Blood Product Molecular Antigen Typing

J05

A57483

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