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

ICD-10 codes for Yervoy Prior Authorizations

C43.9Malignant melanoma of skin, unspecified
C64.9Malignant neoplasm of unspecified kidney, except renal pelvis
C18.9Malignant neoplasm of colon, unspecified
C22.9Malignant neoplasm of liver, not specified as primary or secondary
C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
C45.9Mesothelioma, unspecified
C15.9Malignant neoplasm of esophagus, unspecified

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Coverage Authorization Appeals Coverage Authorization Appeals resource
Commercial Claim Denial Appeal/Redetermination LetterCommercial Claim Denial Appeal/Redetermination Letter resource
Medically Unlikely Edit (MUE) Appeal LetterMedically Unlikely Edit (MUE) Appeal Letter 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 YervoyHow To Order Yervoy resource
Billing & Coding Guide Billing & Coding Guide resource
Formulary InformationFormulary Information resource
Reimbursement InformationReimbursement Information resource

Support for Getting Your Patient on Yervoy

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.