Imlygic 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 May 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 - Imlygic Prior Authorization Form Cigna Corporation · Updated May 16, 2026

ICD-10 codes for Imlygic Prior Authorizations

C8A.9Melanoma of skin, unspecified
C8A.4Melanoma of skin of lower limb and hip
C8A.3Melanoma of skin of upper limb and shoulder
C8A.2Melanoma of skin of trunk

Brand Resources

Billing & Coding Guide - Hospital Outpatient Billing & Coding Guide - Hospital Outpatient resource
Billing & Coding Guide - Physician OfficeBilling & Coding Guide - Physician Office resource
Benefit Verification & PA FormBenefit Verification & PA Form resource
Coverage Authorization Request Coverage Authorization Request resource
How to Order Imlygic How to Order Imlygic resource

Support for Getting Your Patient on Imlygic

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