Asclera 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
Blue Cross Blue Shield of Massachusetts - Treatment of Varicose Veins Venous InsufficiencyBlue Cross Blue Shield of Massachusetts · Updated May 10, 2026
Blue Cross Blue Shield of Massachusetts - Prior Authorization Request Form for Treatment of Varicose Veins Venous InsufficiencyBlue Cross Blue Shield of Massachusetts · Updated May 10, 2026
Blue Cross Blue Shield of Michigan - Echosclerotherapy for the Treatment of Varicose VeinsBlue Cross Blue Shield of Michigan · Updated May 10, 2026
Blue Cross Blue Shield of Rhode Island - Varicose Vein TreatmentBlue 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 11, 2026

ICD-10 codes for Asclera Prior Authorizations

I83.90Asymptomatic varicose veins of unspecified lower extremity
I83.91Asymptomatic varicose veins of right lower extremity
I83.92Asymptomatic varicose veins of left lower extremity
I83.93Asymptomatic varicose veins of bilateral lower extremities

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