Does D57.01 require prior authorization?

No, D57.01 does not require prior authorization (high confidence). Covered without prior authorization.

`D57.01`, Hb-SS disease with acute chest syndrome

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
For Part A claims, enter the appropriate DEX Z-Code identifier adjacent to the CPT/PLA code in the comment/narrative field: use Line SV202-7 for 837I electronic claims or Block 80 for the UB04 claim form.
Include the appropriate ICD-10-CM diagnosis code on the claim when reporting the blood product molecular antigen typing service.

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).
The professional component of visual field testing is payable under Medicare Part B when billed in place of service: Office (11), Off-campus Outpatient Hospital (19), Inpatient Hospital (21), On-campus Outpatient Hospital (22), Emergency Room (23), Skilled Nursing Facility (31), Nursing Facility (32), Independent Clinic (49), and Comprehensive Outpatient Rehabilitation Facility (62).
Non-invasive cerebrovascular/vascular studies are covered when the study results will be used to directly inform or change the clinical management of the patient.

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J15

CGS-J15-L38249, MolDX: Blood Product Molecular Antigen Typing

J15

CGS-J15-L34175, Ophthalmic Angiography (Fluorescein and Indocyanine Green)

J15

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