Simponi 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 Simponi Prior Authorizations

M06.9Rheumatoid arthritis, unspecified
M05.70Rheumatoid arthritis with rheumatoid factor of unspecified site without organ or systems involvement
L40.50Arthropathic psoriasis, unspecified
L40.51Arthropathic psoriasis of hand
M45.9Ankylosing spondylitis of unspecified sites in spine
M45.0Ankylosing spondylitis of multiple sites in spine
K51.9Ulcerative colitis, unspecified
K51.90Ulcerative colitis, unspecified, with complications

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Appeals ChecklistAppeals Checklist resource
Letter of Medical NecessityLetter of Medical Necessity resource
Formulary Exception Considerations ChecklistFormulary Exception Considerations Checklist resource
A peer-to-peer review with the payer's medical director can often resolve denials faster than a formal appeal.

Brand Resources

Billing & CodingBilling & Coding resource
Prior Authorization ChecklistPrior Authorization Checklist resource
Letter of Exception: RheumatologyLetter of Exception: Rheumatology resource
Letter of Exception: Ulcerative ColitisLetter of Exception: Ulcerative Colitis resource

Support for Getting Your Patient on Simponi

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.