Does D57.219 require prior authorization?

No, D57.219 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D57.219` — Sickle-cell/Hb-C disease with crisis, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims must include the referring/ordering physician's name and NPI when required by the service, and all same-day services for the same beneficiary by the same provider must be billed on the same claim.
Medical record must include the ordering provider's assessment related to the visit complaint, relevant medical history, results of pertinent tests, and a signed and dated office visit/operative report.
For fundus photography, retain a copy of the photographs in the record, include an interpretation and report, document whether the pupil was dilated and which drug was used, and maintain legible documentation of medical necessity.
For extended ophthalmoscopy, retain a detailed per-eye retinal drawing (minimum 3–4 inches, labeled; 4–6 colors preferred), document optic nerve drawings for glaucoma with cupping/disc rim/pallor/slope and surrounding pathology, note method of examination and pupil dilation/drug, and document findings and plan.

Fundus photography (CPT 92250, 92228) is covered when medical necessity is documented in the patient's medical record including relevant history, physical exam, results of pertinent tests, an interpretation/report, and retained copies of the photographs.
Extended ophthalmoscopy (CPT 92201, 92202) is covered when medical necessity is documented per-eye with a retinal drawing that meets the policy specifications, relevant history, physical exam, and test results recorded.
Professional (26) and/or technical (TC) components of fundus photography CPT 92250 and 92228 may be billed separately when only one component is performed, with the appropriate modifier reported.
When extended ophthalmoscopy is performed during a global surgical period and is unrelated to the surgery (same provider), bill the extended ophthalmoscopy with modifier 79 (and the appropriate site modifier if unilateral).
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.
Blood Product Molecular Antigen Typing is covered when ordered consistent with the applicable MolDX Local Coverage Determination (LCD) clinical indications.

L38441 — MolDX: Blood Product Molecular Antigen Typing

J05

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

J05

A57483 — Billing and Coding: Visual Fields

J05

L34615 — Visual Fields

J05

L35753 — Non-Invasive Cerebrovascular Studies

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