Does D57.419 require prior authorization?

No, D57.419 does not require prior authorization (high confidence). Covered without prior authorization.

`D57.419`, Sickle-cell thalassemia, unspecified, with crisis

ICD-10-CM

No Prior Auth Required

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.
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.

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.
Blood product molecular antigen typing panels 0001U and 0084U are covered as germline tests when billed consistent with MolDX LCD L38249.
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.
Re-evaluation of carotid artery stenosis is covered for patients with diameter reduction >50% who are symptomatic and these patients are normally followed on an annual basis.
Re-evaluation of carotid artery stenosis is covered for patients with diameter reduction >60% who are asymptomatic and these patients are normally followed on an annual basis.

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

J15

CGS-J18-L38249, MolDX: Blood Product Molecular Antigen Typing

J18

A57592, Billing and Coding: Non-Invasive Cerebrovascular Studies

WPS-J5-L35753, Non-Invasive Cerebrovascular Studies

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