HyQvia 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

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
CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc. · Updated May 11, 2026
Cigna - General Medication Prior Authorization FormCigna Corporation · Updated May 11, 2026
Cigna - Intravenous Immune Globulin (IVIG) -SCIG Prior Authorization Form Cigna Corporation · Updated May 11, 2026

ICD-10 codes for HyQvia Prior Authorizations

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

Brand Resources

Pharmacy List Pharmacy List resource
How To Order HyQvia How To Order HyQvia resource

Support for Getting Your Patient on HyQvia

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HyQvia (immune globulin infusion (human), 10% with recombinant human hyaluronidase) Prior Authorization Forms & ICD-10 Codes | PrescriberPoint