Purified Cortrophin Gel 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
Colorado - Uniform Prior Authorization FormColorado · Updated May 16, 2026

ICD-10 codes for Purified Cortrophin Gel Prior Authorizations

L40.5Arthropathic psoriasis
M06.9Rheumatoid arthritis, unspecified
M45.9Ankylosing spondylitis of unspecified sites in spine
M10.9Gout, unspecified
M32.9Systemic lupus erythematosus, unspecified
M33.9Dermatopolymyositis, unspecified
L51.9Erythema multiforme, unspecified
L40.9Psoriasis, unspecified
L20.9Atopic dermatitis, unspecified
T80.6Other serum reactions
H10.1Acute atopic conjunctivitis
H16.9Unspecified keratitis
H20.0Acute and subacute iridocyclitis
H20.9Unspecified iridocyclitis
H46.9Unspecified optic neuritis
H30.9Unspecified chorioretinal inflammation
D86.9Sarcoidosis, unspecified
N04.9Nephrotic syndrome with unspecified morphologic changes
G35Multiple sclerosis

Brand Resources

Pharmacy List Pharmacy List resource
How To Order Purified Cortrophin GelHow To Order Purified Cortrophin Gel resource
Billing & Coding Guide Billing & Coding Guide resource

Support for Getting Your Patient on Purified Cortrophin Gel

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