Xarelto 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 Xarelto Prior Authorizations

I48.91Unspecified atrial fibrillation
I82.90Unspecified deep vein thrombosis of unspecified site
I26.90Unspecified pulmonary embolism
I25.10Atherosclerotic heart disease of native coronary artery without angina pectoris
I73.9Peripheral vascular disease, unspecified

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Appeals Consideration ChecklistAppeals Consideration Checklist resource
Letter of Medical Necessity Letter of Medical Necessity resource
Letter of Formulary ExceptionLetter of Formulary Exception resource
Formulary Exception Considerations Checklist Formulary Exception Considerations Checklist resource
A peer-to-peer review with the payer's medical director can often resolve denials faster than a formal appeal.

Brand Resources

Billing & Coding GuideBilling & Coding Guide resource

Support for Getting Your Patient on Xarelto

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.