Herceptin 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 Blue Cross and Blue Shield (Wisconsin Medicaid) - Prior Authorization Form for Medical InjectablesAnthem Blue Cross Blue Shield Medicaid · Updated May 10, 2026
Anthem Indiana Medicaid - Medical Injectables Prior Authorization FormAnthem Indiana Medicaid · Updated May 11, 2026
Anthem Kentucky Medicaid - Prior Authorization Form — Medical InjectablesAnthem, 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 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

ICD-10 codes for Herceptin Prior Authorizations

C50.9Malignant neoplasm of breast of unspecified site
C16.9Malignant neoplasm of stomach, unspecified
C16.0Malignant neoplasm of cardia

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Coverage Authorization AppealsCoverage 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
Pharmacy List Pharmacy List resource
How To Order Herceptin How To Order Herceptin resource
Billing & Coding Guide: First-, Second- and Third-line Metastatic Breast CancerBilling & Coding Guide: First-, Second- and Third-line Metastatic Breast Cancer resource
Billing & Coding Guide: Metastatic Gastric CancerBilling & Coding Guide: Metastatic Gastric Cancer resource
Formulary InformationFormulary Information resource

Support for Getting Your Patient on Herceptin

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.