Hyrimoz 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 08, 2026

Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated May 08, 2026
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated May 08, 2026
California - Uniform Prior Authorization FormCalifornia · Updated Apr 16, 2026
CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc. · Updated May 08, 2026
Cigna - General Medication Prior Authorization FormCigna Corporation · Updated May 08, 2026
Colorado - Uniform Prior Authorization FormColorado · Updated Apr 16, 2026

ICD-10 codes for Hyrimoz Prior Authorizations

M06.9Rheumatoid arthritis, unspecified
M06.00Unspecified rheumatoid arthritis with rheumatoid factor of unspecified site or unspecified laterality
M08.9Unspecified juvenile idiopathic arthritis
M08.00Unspecified polyarticular juvenile idiopathic arthritis
L40.50Arthropathic psoriasis, unspecified
L40.51Arthropathic psoriasis, unspecified, site unspecified
M45.9Ankylosing spondylitis of unspecified sites in spine
M45.90Unspecified ankylosing spondylitis of unspecified sites in spine
K50.9Crohn's disease, unspecified
K50.10Crohn's disease of small intestine with rectal bleeding
K51.9Ulcerative colitis, unspecified
K51.90Unspecified ulcerative colitis
L40.9Psoriasis, unspecified
L40.0Psoriasis vulgaris
L73.2Hidradenitis suppurativa
H20.9Unspecified iritis
H30.9Unspecified chorioretinal inflammation

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Coverage Authorization Appeals Coverage Authorization Appeals resource
A peer-to-peer review with the payer's medical director can often resolve denials faster than a formal appeal.

Brand Resources

Reimbursement InformationReimbursement Information resource
Coverage Authorization Request Coverage Authorization Request resource

Support for Getting Your Patient on Hyrimoz

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.