Cyramza 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 24, 2026

Amerigroup - NJ Medicaid Pharmacy Prior Authorization FormAmerigroup · Updated May 10, 2026
Amerigroup - IA Medicaid Outpatient Prior Authorization FormAmerigroup · Updated May 10, 2026
Amerigroup - DC Medicaid Medical Injectable Prior Authorization FormAmerigroup · Updated May 10, 2026
Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated Apr 24, 2026
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated Apr 24, 2026
California - Uniform Prior Authorization FormCalifornia · Updated Apr 16, 2026

ICD-10 codes for Cyramza Prior Authorizations

C16.0Malignant neoplasm of cardia
C16.2Malignant neoplasm of body of stomach
C16.8Malignant neoplasm of overlapping sites of stomach
C16.9Malignant neoplasm of stomach, unspecified
C34.10Malignant neoplasm of upper lobe, unspecified bronchus or lung
C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
C18.9Malignant neoplasm of colon, unspecified
C20Malignant neoplasm of rectum
C22.0Liver cell carcinoma
C22.9Malignant neoplasm of liver, not specified as primary or secondary

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
First-Level Appeal Letter for Commercial or Other InsuranceFirst-Level Appeal Letter for Commercial or Other Insurance resource
Second-Level Appeal Letter for Commercial or Other InsuranceSecond-Level Appeal Letter for Commercial or Other Insurance resource
Letter of Medical NecessityLetter 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

Billing and Coding GuideBilling and Coding Guide resource
First-Level Medicare Review LetterFirst-Level Medicare Review Letter resource
Second-Level Medicare Review LetterSecond-Level Medicare Review Letter resource
Denied Claims ChecklistDenied Claims Checklist resource

Support for Getting Your Patient on Cyramza

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