Breyanzi 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

Anthem Blue Cross Blue Shield Medicaid - Medicaid Managed Care Precertification RequestAnthem Blue Cross Blue Shield 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 Illinois - MMAI BCCHP Pre-Authorization FormBlue Cross Blue Shield of Illinois · Updated May 10, 2026
Blue Cross Blue Shield of Minnesota - Prior Authorization and Formulary Exception FormBlue Cross Blue Shield of Minnesota · Updated Apr 15, 2026
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated May 08, 2026
Bristol-Myers Squibb - Breyanzi Medical Benefit Only Prescriber Prior Authorization FormBristol-Myers Squibb · Updated May 10, 2026

ICD-10 codes for Breyanzi Prior Authorizations

C83.30Diffuse large B-cell lymphoma, unspecified site
C85.80Other specified types of non-Hodgkin lymphoma, unspecified site
C85.20Mediastinal (thymic) large B-cell lymphoma, unspecified site
C82.90Follicular lymphoma, unspecified, unspecified site
C91.10Chronic lymphocytic leukemia of B-cell type not having achieved remission
C83.0Small cell B-cell lymphoma
C83.10Mantle cell lymphoma, unspecified site
C85.10Unspecified B-cell lymphoma, unspecified site

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

Formulary Information Formulary Information resource
Billing & Coding Guide Billing & Coding Guide resource
Breyanzi PA Tip Sheet Breyanzi PA Tip Sheet resource
Coverage Authorization Request Coverage Authorization Request resource

Support for Getting Your Patient on Breyanzi

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.