Leukine 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 Leukine Prior Authorizations

C92.0Acute myeloblastic leukemia
C92.9Myeloid leukemia, unspecified
C85.9Non-Hodgkin lymphoma, unspecified
C82.9Follicular lymphoma, unspecified
C91.00Acute lymphoblastic leukemia not having achieved remission
C91.01Acute lymphoblastic leukemia, in remission
C91.02Acute lymphoblastic leukemia, in relapse
C81.9Hodgkin lymphoma, unspecified
T66Radiation sickness, unspecified

Support for Getting Your Patient on Leukine

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