Rebyota 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 Blue Shield of Massachusetts - 682 Fecal Microbiota TransplantationBlue Cross Blue Shield of Massachusetts · Updated May 10, 2026

Blue Cross Blue Shield of Massachusetts - 682 Fecal Microbiota TransplantationBlue Cross Blue Shield of Massachusetts · Updated May 09, 2026

Blue Cross Blue Shield of Michigan - Alert 20230119 Rebyota Medicare Advantage Prior AuthorizationBlue Cross Blue Shield of Michigan · Updated May 10, 2026

Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated May 11, 2026

Blue Shield of California - 2.01.92 Fecal Microbiota TransplantationBlue Shield of California · Updated May 10, 2026

ICD-10 codes for Rebyota Prior Authorizations

A04.7Enterocolitis due to Clostridium difficile

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.

Coverage Authorization Appeals Coverage Authorization Appeals resource

Letter of Medical Necessity Letter of Medical Necessity resource

A peer-to-peer review with the payer's medical director can often resolve denials faster than a formal appeal.

Brand Resources

Pharmacy List Pharmacy List resource

How To Order Rebyota How To Order Rebyota resource

Billing & Coding Guide Billing & Coding Guide resource

Coverage Authorization Request Coverage Authorization Request resource

Support for Getting Your Patient on Rebyota

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.