Ambien CR 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

Amerigroup - Sedative Hypnotic Non-Benzodiazepine Prior Authorization RequestAmerigroup · Updated May 10, 2026
Anthem - Non-Preferred Sedative Hypnotic Agents for Insomnia Prior AuthorizationAnthem, Inc. · Updated May 10, 2026
Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated May 11, 2026
Blue Cross Blue Shield of Alabama - Medicare Part D Prior Authorization RequestBlue Cross Blue Shield of Alabama · Updated May 10, 2026
Blue Cross Blue Shield of Alabama - Insomnia Agents Step Therapy and Quantity Limit Program SummaryBlue Cross Blue Shield of Alabama · Updated May 10, 2026
Blue Cross Blue Shield of South Carolina - Hypnotic Agents Prior Authorization Form Blue Cross Blue Shield of South Carolina · Updated Apr 16, 2026

ICD-10 codes for Ambien CR Prior Authorizations

G47.00Insomnia, unspecified

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