Austedo XR 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 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
Cigna - Austedo Prior Authorization FormCigna Corporation · Updated Apr 18, 2026

ICD-10 codes for Austedo XR Prior Authorizations

G10Huntingtons disease
G24.09Other drug induced dystonia

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

Reimbursement Information Reimbursement Information resource
Formulary Information: Tardive DyskinesiaFormulary Information: Tardive Dyskinesia resource
Formulary Information: Huntingdon's Disease Chorea Formulary Information: Huntingdon's Disease Chorea resource
Austedo Prescription & Service Request Form For Twice-Daily DosingAustedo Prescription & Service Request Form For Twice-Daily Dosing resource
Austedo (XR) Prescription & Service Request Form For Once-Daily DosingAustedo (XR) Prescription & Service Request Form For Once-Daily Dosing resource

Support for Getting Your Patient on Austedo XR

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.