Policy library / J9161 Commercial payer policies listing J9161 6 policies from 6 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
Arkansas Blue Cross and Blue Shield policies listing J9161, with the code’s status in each Policy Effective Status of J9161 Denileukin diftitox-cxdl (e.g., Lymphir) PayerPolicy · ARKBLUE-DENILEUKIN-DIFTITOX-CXDL-E-G-LYMPHIR Not recorded Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.
BlueCross BlueShield of Tennessee policies listing J9161, with the code’s status in each Policy Effective Status of J9161 Denileukin diftitox-cxdl (Lymphir) PayerPolicy · BCBSTN-e136392040 Mar 3, 2026 Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.
Cigna policies listing J9161, with the code’s status in each Policy Effective Status of J9161 Cigna MedOnc Master Drug List.pdf PayerPolicy · EVICORE-HPLAN-CIGNA-18A0ACC73CE9 Not recorded Prior auth required
Health Net Oregon policies listing J9161, with the code’s status in each Policy Effective Status of J9161 Denileukin Diftitox-cxdl (Lymphir); CP.PHAR.693 PayerPolicy · HEALTHNET_OR-CP-PHAR-693 Not recorded Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.
Health Partners Plans / Jefferson Health Plans policies listing J9161, with the code’s status in each Policy Effective Status of J9161 Q4 - 2026 JHP MedOnc Master Drug List.pdf PayerPolicy · EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-39BC225341EE Not recorded Prior auth required
Moda Health policies listing J9161, with the code’s status in each Policy Effective Status of J9161 Lymphir (denileukin diftitox-cxdl) PayerPolicy · MODA-MODA-MPS-LYMPHIR-DB5540C34F Not recorded Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.