D57.454: Sickle-cell thalassemia beta plus with dactylitis
D57.454, sickle-cell thalassemia beta plus with dactylitis, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 16 HCPCS Level II codes, including J1569 (Injection, immune globulin, (gammagard liquid/gammagard…), J1561 (Injection, immune globulin, (gamunex-c/gammaked)…), J1459 (Injection, immune globulin (privigen), intravenous…). The articles come from 2 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with D57.454 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J1569 | Injection, immune globulin, (gammagard liquid/gammagard liquid erc), 500 mg | Special coverage instructions apply | — | 1 |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 1 |
| J1459 | Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 1 |
| J1576 | Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg | Special coverage instructions apply | — | 1 |
| J1557 | Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 1 |
| J1556 | Injection, immune globulin (bivigam), 500 mg | Carrier judgment | — | 1 |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | Carrier judgment | — | 1 |
| J1566 | Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg | Special coverage instructions apply | — | 1 |
| J1554 | Injection, immune globulin (asceniv), 500 mg | Carrier judgment | — | 1 |
| J1599 | Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg | Carrier judgment | — | 1 |
| J2791 | Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu | Special coverage instructions apply | — | 1 |
| J1552 | Injection, immune globulin (alyglo), 500 mg | Carrier judgment | — | 1 |
| J2792 | Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu | Special coverage instructions apply | — | 1 |
| G0238 | Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring) | Carrier judgment | — | 2 |
| G0237 | Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring) | Carrier judgment | — | 2 |
| G0239 | Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring) | Carrier judgment | — | 2 |
Medicare policy articles listing D57.454
- A56718: Billing and Coding: Intravenous Immunoglobulin (IVIG) (Palmetto GBA (MAC - Part A, MAC - Part B); 13 Level II codes). LCD with the same title: L34580
- A56717: Billing and Coding: Respiratory Therapy (Respiratory Care) (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34430
- A57224: Billing and Coding: Respiratory Care (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L34149
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other D57 diagnoses (Sickle-cell disorders)
- D57.414 — Sickle-cell thalassemia, unspecified, with dactylitis
- D57.434 — Sickle-cell thalassemia beta zero with dactylitis
- D57.01 — Hb-SS disease with acute chest syndrome
- D57.04 — Hb-SS disease with dactylitis
- D57.211 — Sickle-cell/Hb-C disease with acute chest syndrome
- D57.214 — Sickle-cell/Hb-C disease with dactylitis
- D57.811 — Other sickle-cell disorders with acute chest syndrome
- D57.814 — Other sickle-cell disorders with dactylitis
Frequently asked questions
Does Medicare cover D57.454 (Sickle-cell thalassemia beta plus with dactylitis)?
Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list D57.454 as a covered diagnosis for 16 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 D57.454?
The Level II codes from the policies most specific to this diagnosis are J1569 (Injection, immune globulin, (gammagard liquid/gammagard…, 1 article); J1561 (Injection, immune globulin, (gamunex-c/gammaked)…, 1 article); J1459 (Injection, immune globulin (privigen), intravenous…, 1 article); J1576 (Injection, immune globulin (panzyga), intravenous…, 1 article); J1557 (Injection, immune globulin, (gammaplex), intravenous…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list D57.454?
A56718 (Billing and Coding: Intravenous Immunoglobulin (IVIG)); A56717 (Billing and Coding: Respiratory Therapy (Respiratory Care)); A57224 (Billing and Coding: Respiratory Care).
What is ICD-10-CM code D57.454?
D57.454 is the ICD-10-CM code for sickle-cell thalassemia beta plus with dactylitis, in category D57 (Sickle-cell disorders), chapter 3: Diseases of the blood and immune mechanism.
Next steps
- Run a reimbursement report for a device billed under J1569
- Watch J1569 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1569
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 3: Diseases of the blood and immune mechanism · All diagnoses · HCPCS lookup