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

ICD-10 codes for Rituxan Prior Authorizations

C82.90Follicular lymphoma, unspecified, unspecified site
C85.90Non-Hodgkin lymphoma, unspecified, unspecified site
C88.0Waldenström macroglobulinemia
C91.10Chronic lymphocytic leukemia of B-cell type not having achieved remission
C91.12Chronic lymphocytic leukemia of B-cell type in relapse
M06.9Rheumatoid arthritis, unspecified
M31.30Wegener's granulomatosis without renal involvement
M31.31Wegener's granulomatosis with renal involvement
M31.7Microscopic polyangiitis
L10.0Pemphigus vulgaris
C91.00Acute lymphoblastic leukemia not having achieved remission

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Coverage Authorization Appeals: Rheumatoid Arthritis (RA)Coverage Authorization Appeals: Rheumatoid Arthritis (RA) resource
Letter of Medical Necessity: Rheumatoid Arthritis (RA)Letter of Medical Necessity: Rheumatoid Arthritis (RA) resource
Coverage Authorization Appeals: Granulomatosis with Polyangiitis (GPA) & Microscopic Polyangiitis (MPA) or Pemphigus Vulgaris (PV)Coverage Authorization Appeals: Granulomatosis with Polyangiitis (GPA) & Microscopic Polyangiitis (MPA) or Pemphigus Vulgaris (PV) resource
Letter of Medical Necessity: Granulomatosis with Polyangiitis (GPA) & Microscopic Polyangiitis (MPA) or Pemphigus Vulgaris (PV)Letter of Medical Necessity: Granulomatosis with Polyangiitis (GPA) & Microscopic Polyangiitis (MPA) or Pemphigus Vulgaris (PV) resource
Coverage Authorization Appeals: Non Hogkin's Lymphoma (NHL) & Chronic Lymphocytic Leukemia (CLL)Coverage Authorization Appeals: Non Hogkin's Lymphoma (NHL) & Chronic Lymphocytic Leukemia (CLL) resource
Letter of Medical Necessity: Non Hogkin's Lymphoma (NHL) & Chronic Lymphocytic Leukemia (CLL)Letter of Medical Necessity: Non Hogkin's Lymphoma (NHL) & Chronic Lymphocytic Leukemia (CLL) resource
A peer-to-peer review with the payer's medical director can often resolve denials faster than a formal appeal.

Brand Resources

Formulary Coverage: All Indications Formulary Coverage: All Indications resource
Pharmacy List Pharmacy List resource
How To Order RituxanHow To Order Rituxan resource
Billing & Coding Guide: Rheumatoid Arthritis (RA)Billing & Coding Guide: Rheumatoid Arthritis (RA) resource
Billing & Coding Guide: Pemphigus Vulgaris (PV)Billing & Coding Guide: Pemphigus Vulgaris (PV) resource
Billing & Coding Guide: Granulomatosis With Polyangiitis (GPA) and Microscopic Polyangiitis (MPABilling & Coding Guide: Granulomatosis With Polyangiitis (GPA) and Microscopic Polyangiitis (MPA resource
Billing & Coding Guide: Adult Chronic Lymphoid LeukemiaBilling & Coding Guide: Adult Chronic Lymphoid Leukemia resource
Billing & Coding Guide: Pediatric Non-Hodgkin’s Lymphoma (NHL) and Acute Lymphoblastic Leukemia (ALL)Billing & Coding Guide: Pediatric Non-Hodgkin’s Lymphoma (NHL) and Acute Lymphoblastic Leukemia (ALL) resource
Billing & Coding Guide: Adult Non-Hodgkin’s Lymphoma (NHL)Billing & Coding Guide: Adult Non-Hodgkin’s Lymphoma (NHL) resource
Prescriber Service Form: RA, GPA & MPA or PV Prescriber Service Form: RA, GPA & MPA or PV resource
Prescriber Service From (Online): All IndicationsPrescriber Service From (Online): All Indications resource

Support for Getting Your Patient on Rituxan

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