Hizentra 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.

Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield
Blue Cross Blue Shield of Michigan - IVIG Medical Benefit Drug Prior Authorization Submission GuideBlue Cross Blue Shield of Michigan
Blue Cross Blue Shield of Michigan - FEP Immune Globulin Replacement Therapy SC Prior Authorization Form (Medical Benefit)Blue Cross Blue Shield of Michigan
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc.
California - Uniform Prior Authorization FormCalifornia
CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc.

ICD-10 codes for Hizentra Prior Authorizations

D80.9Immunodeficiency with predominantly antibody defects, unspecified
G61.81Chronic inflammatory demyelinating polyneuritis
D82.0Wiskott-Aldrich syndrome
D83.9Common variable immunodeficiency, unspecified
D80.0Hereditary hypogammaglobulinemia
D81.9Combined immunodeficiency, unspecified

Brand Resources

Billing & Coding Guide: Primary Immune Deficiency (PI)Billing & Coding Guide: Primary Immune Deficiency (PI) resource
Billing & Coding Guide: Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)Billing & Coding Guide: Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) resource
Reimbursement InformationReimbursement Information resource

Support for Getting Your Patient on Hizentra

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