ICD-10 Codes
- Benefits Investigation & Prescription Form - Dermatology & RheumatologyA way to find out if STELARA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies.
Benefits Investigation & Prescription Form - Dermatology & Rheumatology (en español para Puerto Rico) - Benefits Investigation & Prescription Form - Dermatology & Rheumatology (en español para Puerto Rico)A way to find out if STELARA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies. En español.
- Business Associate AgreementComplete a Business Associate Agreement for your practice only once. No individual patient authorizations are required.
- Delay & Denial Support Reverification GuideUse this guide to learn how to confirm your patient's eligibility for Delay & Denial Support/Janssen Link if they have previously been eligible.
- Enrollment & Prescription Form - GastroenterologyA way to find out if STELARA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies.
- Enrollment & Prescription Form - Gastroenterology (en español para Puerto Rico)A way to find out if STELARA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies. En español.
- Letter of Exception (Crohn’s Disease)A template that you can fill out and submit to a patient’s health insurance provider asking them to cover a medication that is not on formulary.
- Letter of Exception (Plaque Psoriasis)A template that you can fill out and submit to a patient’s health insurance provider asking them to cover a medication that is not on formulary.
- Letter of Exception (Psoriatic Arthritis)A template that you can fill out and submit to a patient’s health insurance provider asking them to cover a medication that is not on formulary.
- Letter of Exception (Ulcerative Colitis)A template that you can fill out and submit to a patient’s health insurance provider asking them to cover a medication that is not on formulary.
- Letter of Medical NecessityA template that you can fill out and submit to a patient’s health insurance provider. You may use it to explain why STELARA® is medically necessary for your patient.
- Patient Affordability OptionsDiscover options that can make STELARA® more affordable for your patients.
- Patient Authorization FormIndividual patient form for offices without a Business Associate Agreement.
Patient Authorization Form (en español) - Patient Authorization Form (en español)Individual patient form for offices without a Business Associate Agreement.
- Prescribing Information & Medication Guide (en español)Product information for STELARA®. En español.
- Resource GuideA comprehensive summary of support tools for your office to help patients start and stay on treatment.
- Savings Program Additional Co-pay Support Form
- Savings Program Assignment of Benefits FormA form the patient can submit that allows Janssen CarePath to reimburse the provider directly.
- Savings Program EOB Clarification FormUse this form when the Explanation of Benefits (EOB) statement does not indicate that the patient received STELARA®.
- Savings Program OverviewEligible patients using commercial or private insurance can save on out-of-pocket costs for STELARA®.
- Savings Program Patient Enrollment FormFax or mail this completed form to enroll your patient in the Savings Program for STELARA®.
- Savings Program Rebate FormA form the patient can submit if the pharmacy isn’t able to process the Janssen CarePath Savings Program card.
- Specialty Distributors for IV Infusion
- Verification of Benefits Guide (Medical)A guide to understanding the Verification of Benefits for your patient’s medical benefits.
- Verification of Benefits Guide (Pharmacy)A guide to understanding the Verification of Benefits for your patient’s pharmacy benefits.

ICD-10 Codes
Click below to see the ICD-10 codes.
Click below to see the ICD-10 codes.
Psoriatic Arthritis
ICD-10 Indication | ICD-10 Code |
Arthropathic Psoriasis | L40 |
Arthropathic psoriasis | L40.5 |
Arthropathic psoriasis, unspecified | L40.50 |
Distal interphalangeal psoriatic arthropathy | L40.51 |
Psoriatic arthritis mutilans | L40.52 |
Psoriatic spondylitis | L40.53 |
Psoriatic juvenile arthropathy | L40.54 |
Other psoriatic arthropathy | L40.59 |
Plaque Psoriasis
ICD-10 Indication | ICD-10 Code |
Psoriasis | L40 |
Psoriasis vulgaris (Plaque psoriasis) | L40.0 |
Plaque psoriasis |
Regional Enteritis / Crohn’s Disease
ICD-10 Indication | ICD-10 Code |
Crohn's disease (regional enteritis) | K50 |
Crohn's disease of small intestine without complications | K50.00 |
Crohn's disease of small intestine with complications | K50.01 |
Crohn's disease of large intestine without complications | K50.10 |
Crohn's disease of large intestine with complications | K50.11 |
Crohn's disease of both small and large intestine without complications | K50.80 |
Crohn's disease of both small and large intestine with complications | K50.81 |
Crohn's disease, unspecified, without complications | K50.90 |
Crohn's disease, unspecified, with complications | K50.91 |
Ulcerative Colitis
ICD-10 Indication | ICD-10 Code |
Ulcerative Colitis | K51 |
Ulcerative (chronic) pancolitis without complications | K51.00 |
Ulcerative (chronic) pancolitis with complications | K51.01 |
Ulcerative (chronic) proctitis without complications | K51.20 |
Ulcerative (chronic) proctitis with complications | K51.21 |
Ulcerative (chronic) rectosigmoiditis without complications | K51.30 |
Ulcerative (chronic) rectosigmoiditis with complications | K51.31 |
Left sided colitis without complications | K51.50 |
Left sided colitis with complications | K51.51 |
Other ulcerative colitis without complications | K51.80 |
Other ulcerative colitis with complications | K51.81 |
Ulcerative colitis, unspecified, without complications | K51.90 |
Ulcerative colitis, unspecified, with complications | K51.91 |
Collected in 10/21 and may change.
This information is not a promise of coverage or payment. It is not intended to give reimbursement advice or increase reimbursement by any payer. Legal requirements and plan information can be updated frequently. Contact the plan for more information about current coverage, reimbursement policies, restrictions, or requirements that may apply.
For more information on ICD-10, visit the CMS website.
SOURCE
ICD-10-CM 2022: The Complete Official Codebook. American Medical Association, 2021.