Pregabalin - Pregabalin capsule 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.

California - Uniform Prior Authorization FormCalifornia
Colorado - Uniform Prior Authorization FormColorado
Illinois - Uniform Prior Authorization FormIllinois
Indiana - Uniform Prior Authorization FormIndiana
Louisiana - Uniform Prior Authorization FormLouisiana
Minnesota - Uniform Prior Authorization FormMinnesota

ICD-10 codes for Pregabalin - Pregabalin capsule Prior Authorizations

E11.42Type 2 diabetes mellitus with diabetic polyneuropathy
E10.42Type 1 diabetes mellitus with diabetic polyneuropathy
E13.42Other specified diabetes mellitus with diabetic polyneuropathy
B02.29Other postherpetic nervous system involvement
G40.109Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus
G40.209Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus
G40.009Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus
M79.7Fibromyalgia
G89.4Chronic pain syndrome
G95.89Other specified diseases of spinal cord

Support for Getting Your Patient on Pregabalin - Pregabalin capsule