Keytruda 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.

Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc.
California - Uniform Prior Authorization FormCalifornia
CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc.
Cigna - General Medication Prior Authorization FormCigna Corporation
Cigna - Keytruda Prior Authorization Form Cigna Corporation

ICD-10 codes for Keytruda Prior Authorizations

C43Malignant melanoma of skin
C43.9Malignant melanoma of skin, unspecified
C34Malignant neoplasm of bronchus and lung
C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
C45.0Mesothelioma of pleura
C45.9Mesothelioma, unspecified
C14.0Malignant neoplasm of pharynx, unspecified
C32.9Malignant neoplasm of larynx, unspecified
C06.9Malignant neoplasm of mouth, unspecified
C81.1Nodular sclerosis Hodgkin lymphoma
C81.2Mixed cellularity Hodgkin lymphoma
C81.3Lymphocyte depleted Hodgkin lymphoma
C81.4Lymphocyte-rich Hodgkin lymphoma
C81.9Hodgkin lymphoma, unspecified
C85.2Mediastinal (thymic) large B-cell lymphoma
C85.20Mediastinal (thymic) large B-cell lymphoma, unspecified site
C67Malignant neoplasm of bladder
C67.9Malignant neoplasm of bladder, unspecified
C80Malignant neoplasm without specification of site
C18Malignant neoplasm of colon
C18.9Malignant neoplasm of colon, unspecified
C19Malignant neoplasm of rectosigmoid junction
C20Malignant neoplasm of rectum
C16Malignant neoplasm of stomach
C16.9Malignant neoplasm of stomach, unspecified
C15Malignant neoplasm of esophagus
C15.9Malignant neoplasm of esophagus, unspecified
C53Malignant neoplasm of cervix uteri
C53.9Malignant neoplasm of cervix uteri, unspecified
C22.0Liver cell carcinoma
C24.9Malignant neoplasm of biliary tract, unspecified
C22.1Intrahepatic bile duct carcinoma
C24.0Malignant neoplasm of extrahepatic bile duct
C23Malignant neoplasm of gallbladder
C4AMerkel cell carcinoma
C4A.9Merkel cell carcinoma, unspecified
C64Malignant neoplasm of kidney, except renal pelvis
C64.9Malignant neoplasm of unspecified kidney, except renal pelvis
C54Malignant neoplasm of corpus uteri
C54.9Malignant neoplasm of corpus uteri, unspecified
C44.92Squamous cell carcinoma of skin, unspecified
C50Malignant neoplasm of breast
C50.919Malignant neoplasm of unspecified site of unspecified female breast
C56Malignant neoplasm of ovary
C56.9Malignant neoplasm of unspecified ovary
C57.0Malignant neoplasm of fallopian tube
C57.00Malignant neoplasm of unspecified fallopian tube
C48.2Malignant neoplasm of peritoneum, unspecified
C48.1Malignant neoplasm of specified parts of peritoneum

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Appeals Checklist Appeals Checklist resource
Coverage Authorization Appeals Coverage Authorization Appeals 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
Prior Authorization Checklist Prior Authorization Checklist resource
Coverage Authorization Request Coverage Authorization Request resource
Reimbursement InformationReimbursement Information resource

Support for Getting Your Patient on Keytruda

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