Actemra Prior Authorization Resources

Find the right PA form for your patient's payer, get the ICD-10 codes you need, and download appeal templates — all in one place.

Last verified: May 11, 2026

Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated May 11, 2026
ATRIO Health Plans - Part B Prior Authorization Request FormATRIO Health Plans, Inc. · Updated May 09, 2026
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated May 11, 2026
California - Uniform Prior Authorization FormCalifornia · Updated Apr 16, 2026
CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc. · Updated May 11, 2026
Cigna - General Medication Prior Authorization FormCigna Corporation · Updated May 11, 2026

ICD-10 codes for Actemra Prior Authorizations

M05.9Rheumatoid arthritis with rheumatoid factor, unspecified
M06.9Rheumatoid arthritis, unspecified
M31.5Giant cell arteritis with polymyalgia rheumatica
M31.6Other giant cell arteritis
M34.81Systemic sclerosis with lung involvement
M08.3Juvenile rheumatoid polyarthritis (seronegative)
M08.2Juvenile rheumatoid arthritis with systemic onset
D89.83Cytokine release syndrome
U07.1COVID-19

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Coverage Authorization Appeals Coverage Authorization Appeals resource
Letter of Medical Necessity Letter of Medical Necessity resource
A peer-to-peer review with the payer's medical director can often resolve denials faster than a formal appeal.

Brand Resources

Pharmacy List Pharmacy List resource
How To Order Actemra How To Order Actemra resource
Formulary Information: RAFormulary Information: RA resource
Billing & Coding Guide: SC InjectionBilling & Coding Guide: SC Injection resource
Billing & Coding Guide: IV InfusionBilling & Coding Guide: IV Infusion resource
Rheumatology Subsequent Verification Program (RSVP) Enrollment FormRheumatology Subsequent Verification Program (RSVP) Enrollment Form resource

Support for Getting Your Patient on Actemra

Check coverage & formulary statusVerify PA requirements for your patient's plan.Find savings programsCopay cards, patient assistance, and more.Check medication interactionsScreen prescriptions for harmful drug combinations.