Omeprazole - Omeprazole capsule, Delayed Release 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 Omeprazole - Omeprazole capsule, Delayed Release Prior Authorizations

K26.9Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation
B96.81Helicobacter pylori [H. pylori] as the cause of diseases classified elsewhere
K25.9Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation
K21.0Gastro-esophageal reflux disease with esophagitis
K21.9Gastro-esophageal reflux disease without esophagitis
E16.4Increased secretion of gastrin
D44.8Neoplasm of uncertain behavior of pluriglandular involvement
D47.02Systemic mastocytosis

Support for Getting Your Patient on Omeprazole - Omeprazole capsule, Delayed Release

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