Kymriah 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 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.
Cigna - General Medication Prior Authorization FormCigna Corporation
Colorado - Uniform Prior Authorization FormColorado

ICD-10 codes for Kymriah Prior Authorizations

C91.0Acute lymphoblastic leukemia [ALL]
C91.00Acute lymphoblastic leukemia not having achieved remission
C91.02Acute lymphoblastic leukemia, in relapse
C83.3Diffuse large B-cell lymphoma
C83.30Diffuse large B-cell lymphoma, unspecified site
C83.39Diffuse large B-cell lymphoma, extranodal and solid organ sites
C82.9Follicular lymphoma, unspecified
C82.90Follicular lymphoma, unspecified, unspecified site
C82.99Follicular lymphoma, unspecified, extranodal and solid organ sites

Brand Resources

Billing & Coding Guide Billing & Coding Guide resource

Support for Getting Your Patient on Kymriah

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