Does K57.00 require prior authorization?

No, K57.00 does not require prior authorization (high confidence). Covered without prior authorization.

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

ICD-10-CM

No Prior Auth Required

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.

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.
No covered indications are explicitly listed in this CPB. The bulletin primarily designates adoptive immunotherapy and cellular therapy approaches described below as experimental and investigational (i.e., not supported as effective).
Note / exception: "This policy does not apply to lifileucel for the treatment of advanced melanoma." (lifileucel is handled separately).
For CAR T therapies and specific agent coverage consult the related CPBs referenced (e.g., CPB 0920 Kymriah, CPB 0924 Yescarta, CPB 0980 Tecartus, CPB 0986 Breyanzi, CPB 0992 Abecma, CPB 1007 Carvykti).

CGS-J15-L34005, Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J15

CGS-J18-L34005, Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J18

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

AETNA-CPB-0396, Gastrointestinal Function: Selected Tests

AETNA-CPB-0535, Virtual Gastrointestinal Endoscopy

AETNA-CPB-0586, Heart Transplantation

AETNA-CPB-0605, Intestinal Transplantation

AETNA-CPB-0641, Adoptive Immunotherapy and Cellular Therapy

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

A56456, Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

A56632, Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

ANTHEM-CG-LAB-21, Serum Iron Testing