Does K57.00 require prior authorization?

No, K57.00 does not require prior authorization (high confidence). Code is covered without prior authorization.

`K57.00` — Diverticulitis of small intestine with perforation and abscess without bleeding

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
All services ordered or rendered must be signed and dated in the medical record, including a signed and dated office visit record or operative report.
An Advance Beneficiary Notice (ABN), Form CMS-R-131, should be signed by the beneficiary when applicable to indicate acceptance of financial responsibility.
The patient's medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit.

Colonoscopy/sigmoidoscopy/proctosigmoidoscopy is covered for surveillance of colonic neoplasia in patients with a history of colorectal cancer or colonic polyps.
A follow-up procedure is covered 1 year after surgery for treatment of colorectal cancer when the patient is identified as high-risk for colon cancer and is eligible for continued screenings.
Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
EGD is covered for persistent upper abdominal distress (e.g., gastroesophageal reflux disease) that continues despite an appropriate trial of symptomatic therapy.
EGD is covered for upper abdominal distress accompanied by a short history of concerning signs or symptoms such as weight loss, anorexia, vomiting, or NSAID/other gastric irritant intake.
EGD is covered for patients older than 40 years who have a significant history of heartburn that recurs after a course of symptomatic therapy.

L33583 — Diagnostic and Therapeutic Esophagogastroduodenoscopy

J09

A57063 — Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

J09

AETNA-CPB-0586 — Heart Transplantation

AETNA-CPB-0605 — Intestinal Transplantation

AETNA-CPB-0641 — Adoptive Immunotherapy and Cellular Therapy

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