Does J9161 require prior authorization?

Yes, J9161 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9161?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Authorization of 12 months may be granted for treatment of stage I-III cutaneous T-cell lymphoma.
Authorization of 12 months may be granted for continued treatment in members requesting reauthorization for an indication listed in the coverage criteria section when there is no evidence of unacceptable toxicity or disease progression while on the current regimen.
Ophthalmic examination at baseline and periodically during therapy as clinically indicated.
Prior authorization is valid for 6 months (180 days) at initial approval.
Indication: The patient has an inadequate response to bexarotene or mogamulizumab as subsequent systemic therapy (if clinically appropriate and not previously used, unless contraindicated or intolerant) prior to approval of denileukin diftitox-cxdl.