Adempass 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 08, 2026

Amerigroup - Adempas Prior AuthorizationAmerigroup · Updated May 10, 2026

Anthem Indiana Medicaid - Request for Prior Authorization Pulmonary HypertensivesAnthem Indiana Medicaid · Updated May 10, 2026

Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated May 08, 2026

Blue Cross Blue Shield of Rhode Island - Adempas Prior Authorization with Quantity Limit Program SummaryBlue Cross Blue Shield of Rhode Island, Inc. · Updated May 10, 2026

Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated May 08, 2026

Blue Shield of California - FEP Adempas Prior Approval RequestBlue Shield of California · Updated May 10, 2026

ICD-10 codes for Adempass Prior Authorizations

I27.24Chronic thromboembolic pulmonary hypertension

I27.20Pulmonary hypertension, unspecified

I27.21Secondary pulmonary arterial hypertension

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