Baxdela 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

Anthem (WellPoint) - Texas Medicaid Prior Authorization RequirementsAnthem, 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 Texas - Rx UM Program Clinical Criteria TexasBlue Cross Blue Shield of Texas · Updated May 10, 2026
Blue Cross Blue Shield of Texas - Prior Authorization Balanced Drug List TexasBlue Cross Blue Shield of Texas · Updated May 10, 2026
Blue Cross Blue Shield of Texas - Prior Authorization Performance Drug List TexasBlue Cross Blue Shield of Texas · 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 Baxdela Prior Authorizations

L03.90Cellulitis, unspecified
L08.9Local infection of the skin and subcutaneous tissue, unspecified
L08.0Pyoderma
J18.0Bronchopneumonia, unspecified organism
J18.9Pneumonia, unspecified organism

Support for Getting Your Patient on Baxdela

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Baxdela (delafloxacin meglumine) Prior Authorization Forms & ICD-10 Codes | PrescriberPoint