Brilinta 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: Apr 16, 2026

California - Uniform Prior Authorization FormCalifornia · Updated Apr 16, 2026
Colorado - Uniform Prior Authorization FormColorado · Updated Apr 16, 2026
Illinois - Uniform Prior Authorization FormIllinois · Updated Apr 16, 2026
Indiana - Uniform Prior Authorization FormIndiana · Updated Apr 16, 2026
Louisiana - Uniform Prior Authorization FormLouisiana · Updated Apr 16, 2026
Minnesota - Uniform Prior Authorization FormMinnesota · Updated Apr 16, 2026

ICD-10 codes for Brilinta Prior Authorizations

I24.9Acute ischemic heart disease, unspecified
I21.9Acute myocardial infarction, unspecified
I25.10Atherosclerotic heart disease of native coronary artery without angina pectoris
I63.9Cerebral infarction, unspecified
G45.9Transient cerebral ischemic attack, unspecified
T82.897AOther specified complication of cardiac prosthetic devices, implants and grafts, initial encounter

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