Does D57.438 require prior authorization?

No, D57.438 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D57.438` — Sickle-cell thalassemia beta zero with crisis with other specified complication

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.
The medical record must contain relevant medical history, physical examination, and results of pertinent diagnostic tests that fully support the medical necessity of each non-invasive vascular study.
Diagnostic tests must be ordered by the treating practitioner (or consulting physician) who will use the test results in managing the patient's specific medical problem; the ordering practitioner's name and NPI must be reported on the claim when required.
Providers of interpretations and technical personnel must maintain documentation of training, licensure, certification, and proficiency for post-payment audit; IDTF supervising physicians must document proficiency in each diagnostic procedure performed.

Non-invasive vascular studies (duplex scan, physiologic studies, plethysmography, transcranial Doppler) are covered when ordered by the treating or consulting practitioner and medically necessary to evaluate, diagnose, or manage vascular disease.
Initial autogenous access vessel mapping should be billed with HCPCS codes 93985 or 93986 and is covered when medically necessary for surgical planning.
Subsequent autogenous access mapping may be billed with CPT codes 93970 or 93971 when clinically indicated.
Pre-surgical radial artery conduit mapping may be performed and accompanied by vein-mapping when either study shows insufficient conduits for multiple bypass procedures.
Immediate post-operative studies of an access or bypass site are covered if pulses are lost, become equivocal, or the patient develops signs or symptoms of ischemia suggesting need for repeat intervention.
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.

A57592 — Billing and Coding: Non-Invasive Cerebrovascular Studies

J05

L38441 — MolDX: Blood Product Molecular Antigen Typing

J05

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

J05

L35753 — Non-Invasive Cerebrovascular Studies

J05

L33627

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