Lupron Depot 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 - Gonadotropin-releasing Hormone (GnRH) Antagonists Prior Authorization Form Cigna Corporation · Updated Apr 16, 2026

ICD-10 codes for Lupron Depot Prior Authorizations

N80.9Endometriosis, unspecified
N80.0Endometriosis of uterus
D25.9Leiomyoma of uterus, unspecified

Brand Resources

How To Order Lupron Depot: Advanced Prostate Cancer How To Order Lupron Depot: Advanced Prostate Cancer resource
Coding & Billing Information: Advanced Prostate CancerCoding & Billing Information: Advanced Prostate Cancer resource

Support for Getting Your Patient on Lupron Depot

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