Does D57.458 require prior authorization?

No, D57.458 does not require prior authorization (high confidence). Covered without prior authorization.

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`D57.458`, Sickle-cell thalassemia beta plus with crisis with other specified complication

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims must report the appropriate CPT code for the flow cytometry service, include 1 unit of service (UOS), and list the appropriate ICD-10-CM diagnosis code.
Medical necessity documentation per LCD L34513 is required when coverage criteria are not fully met in this billing guideline (for example, when >24 markers are requested).
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.

The patient's medical record must include the ordering provider's assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report.

Key Coverage Criteria

Coverage and medical necessity determinations for flow cytometry are governed by Local Coverage Determination L34513.
Flow cytometry may be used to analyze cellular components of body fluids and lymphoreticular tissues, including peripheral blood, cerebrospinal fluid (CSF), bone marrow, lymph nodes, tonsil, spleen, and fine needle aspirate material.
Peripheral blood or fine needle aspirate specimens may be used to avoid more invasive diagnostic procedures when clinically appropriate.
CPT 88182 reports the physician professional and facility technical components of DNA ploidy and S-phase analysis of tumor by flow cytometry.
CPT 88184 (first marker) and CPT 88185 (each additional marker) report the facility technical component of flow cytometric immunophenotyping for assessment of potential hematolymphoid neoplasia.
Flow cytometry interpretation is reported using CPT codes 88187–88189 (one interpretation code per specimen).

20 Active Policies

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

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J18-L34037, Flow Cytometry

J18

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

J18

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

WPS-J5-L38441, MolDX: Blood Product Molecular Antigen Typing

WPS-J5-L35753, Non-Invasive Cerebrovascular Studies

A57592, Billing and Coding: Non-Invasive Cerebrovascular Studies

NGS-J6-L33627, Non-Invasive Vascular Studies

A56758, Billing and Coding: Non-Invasive Vascular Studies

WPS-J8-L38441, MolDX: Blood Product Molecular Antigen Typing

WPS-J8-L35753, Non-Invasive Cerebrovascular Studies

NGS-JK-L33627, Non-Invasive Vascular Studies

A58308, Billing and Coding: MolDX: Blood Product Molecular Antigen Typing

UHC-POL-adakveo-crizanlizumab-tmca, Adakveo (Crizanlizumab-Tmca)

A55717, Billing and Coding: Lab: Flow Cytometry

A56421, Billing and Coding: CT of the Abdomen and Pelvis

A56464, Billing and Coding: Flow Cytometry

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

A56774, Billing and Coding: Ophthalmic Angiography (Fluorescein and Indocyanine Green)

`D57.458`, Sickle-cell thalassemia beta plus with crisis with other specified complication

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

D57.458, Sickle-cell thalassemia beta plus with crisis with other specified complication

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`D57.458`, Sickle-cell thalassemia beta plus with crisis with other specified complication